A systematic review and meta-analysis of HIV transmission risk behaviors, genetic variations, and antiretroviral (ARV) resistance in LGBT populations

Dewi Ratna Sulistina; Santi Martini; Budi Prasetyo; Firman Suryadi Rahman; Arga Setyo Adji; Chung-Yi Li; Maria Inge Lusida

doi:10.1177/22799036241239464

A systematic review and meta-analysis of HIV transmission risk behaviors, genetic variations, and antiretroviral (ARV) resistance in LGBT populations

J Public Health Res. 2024 Apr 14;13(2):22799036241239464. doi: 10.1177/22799036241239464. eCollection 2024 Apr.

Authors

Dewi Ratna Sulistina^{1

2}, Santi Martini³, Budi Prasetyo⁴, Firman Suryadi Rahman⁵, Arga Setyo Adji⁶, Chung-Yi Li⁷, Maria Inge Lusida^{8

9}

Affiliations

¹ Doctoral Study Program, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia.
² Department of Sport Science, Faculty of Sport Science, State University of Malang, Malang, Indonesia.
³ Division of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia.
⁴ Department of Social Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
⁵ Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia.
⁶ Faculty of Medicine, Hang Tuah University, Surabaya, East Java, Indonesia.
⁷ Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁸ Department of Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
⁹ Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.

Abstract

Background: Currently, human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) has become one of the major health problems worldwide, including Indonesia. East Java is one of the provinces in Indonesia with the highest prevalence of HIV infection. One of the causes of HIV infection transmission is lesbian, gay, bisexual, and transgender (LGBT) practice. Furthermore, the treatment using antiretroviral (ARV) drugs in HIV-1 patients can fail due to the presence of HIV drug resistance.

Objective: The aim of this study is to identify the behavior at risk of HIV transmission among LGBT, patterns of genetic variation and antiretroviral (ARV) resistance.

Methods: A systematic review and meta-analysis based on the PRISMA guidelines was conducted. We searched three databases including PubMed, ScienceDirect, and Google scholar for studies investigating the non-heterosexual behavior as risk factor of HIV infection and antiretroviral resistance. Only studies published in English are considered. The adjusted estimates of the risk were carried out using best-adjusted OR with 95% confidence interval (CI) and significant p value < 0.05.

Results: In the quantitative analysis of HIV infection risk factors, a total of 13 studies were included, which investigated non-heterosexual behavior as a potential factor. The studies involved a total of 37,129 participants, comprising 10,449 individuals in the non-heterosexual behavior group (LGBTQ+) and 26,680 individuals in the heterosexual group. The majority of the participants in this study were from the USA, Japan, China, and Brazil, and the main HIV subgenotypes were B and CRF. Additionally, the antiretroviral resistance of HIV patients was examined, involving a total of 3062 individuals, with 1296 individuals in the non-heterosexual behavior group and 1766 individuals in the heterosexual group. Our calculation showed that non-heterosexual behavior was significant as risk factor of HIV infection (OR = 2.17, 95% CI = 1.94-2.43, p < 0.001) and antiretroviral resistance (OR = 1.31, 95% CI = 1.00-1.71, p = 0.05).

Conclusion: This study concludes that non heterosexual behavior is significant risk factor of HIV infection. A quite prevalent of antiretroviral resistance were found among non heterosexual behavior. The main subgenotype of HIV are B and CRF.

Keywords: LGBTQ; antiretroviral (ARV) resistance; behavior.