The impact of the M184V resistance mutation on treatment outcomes in patients with HIV infection: a systematic review and meta-analysis

Abstract

HIV is a global deliberating infectious disease. Of note, more than 36 million people living with HIV (PLHIV) with approximately newly diagnosed 1.5 million cases annually. M184V is a single base mutation in the highly conserved YMDD domain of reverse transcriptase (RT). It is one of the most encountered resistances associated with mutations to nucleoside RT inhibitors. There were continuous efforts to evaluate the impact of M184V mutation on the treatment outcomes in PLHIV. Therefore, the present systematic review was executed to reveal the virological failure, virological suppression, and resistance to antiretroviral therapy (ART) regimens in PLHIV with the M184V mutation. All clinical studies comparing the treatment outcomes among PLHIV harboring or not harboring M184V mutation were appropriate for systematic review and meta-analysis. The present systematic review included six articles, encompassing 4760 PLHIV. Of them, 1222 (25.67%) patients had M184V mutation, while 3538 (74.32%) PLHIV did not. The meta-analysis showed that patients with M184V mutation were 1.87 times more liable to virological failure (risk ratio [RR] 1.87; 95% 1.09, 3.20; p = 0.02). Furthermore, pooling the data from two studies revealed a significantly higher risk of viral blips (RR 2.26; 95% 1.47, 3.46; p = 0.0002). Concerning discontinuation of ART, there was no statistical difference between patients with and without M184V mutation (RR: 0.99; 95% 0.78, 1.25; p = 0.90). The present study revealed the negative impact of the M184V mutation on treatment outcomes in PLHIV. This included a higher risk of virological failure and viral blips, relative to patients without the mutation. Such patients may benefit from more aggressive and combined therapy for better disease management.