(P139) Understanding the Burden of Antimicrobial Resistance among HIV Patients in Nigeria: A Systematic Review

Background

Antimicrobial resistance (AMR) poses a significant threat to global health, disproportionately affecting low and middle-income countries. People living with HIV face unique challenges, including the need for lifelong medication and compromised immunity, making them particularly vulnerable to antimicrobial-resistant infections, which can greatly impact their survival and overall health. This study aims to investigate the impact of AMR on HIV patients in a resource-limited setting like Nigeria.



Method

Recent studies from 2010 to January 2023 were searched on various databases such as PubMed, Google Scholar, Lilac, and other relevant sources using PRISMA guidelines for systematic reviews. A structured search string and strict inclusion/exclusion criteria were applied to retrieve and screen the articles. Only original studies relevant to the research context were included.



Result

After a thorough screening process, 16 papers that met the study criteria were selected from the 92 papers retrieved. The review found a scarcity of studies that estimate the direct mortality rate associated with AMR in HIV-infected patients. Studies have shown an association between resistant HBV secondary infections and increased viral load (6.77 log IU/ml). Two studies reported 712 cases of drug-resistant tuberculosis, with high rates of comorbidities, particularly anaemia, and a death rate of 38 out of 147 DR-TB cases. Additionally, there was a high prevalence of multidrug resistance to second-line drugs used for antibiotics. Candida infections were found to be resistant to antifungal drugs such as fluconazole, flucytosine, itraconazole, and voriconazole, with fluconazole-resistant strains of oropharyngeal yeast-like cells reported in 9.5% (n=213) of cases. Furthermore, 27.1% of pre-treatment HIV drug resistance was reported in PMTCT-naive children, which was associated with treatment failure and subsequent death. Infants infected with HIV were also found to have drug-resistant infections.



Conclusion

The study found that the prevalence of multidrug-resistant infections among HIV-infected patients is high, with a high incidence of multidrug tuberculosis infections and associated deaths. Additionally, secondary fungal infections among HIV patients are becoming increasingly resistant to antifungals, and even infants are showing resistance before treatment begins. These findings highlight the urgent need for improved surveillance of AMR among HIV patients and the implementation of antimicrobial stewardship strategies.