High prevalence of baseline Non-R5 viral tropism in PLWH is associated with immune damage: A systematic review and meta-analysis

Yangyang Liu¹Defu Yuan¹Yueqi Yin²Qian He³Meng Zhao¹Hongfei Ma¹Pingmin Wei^1*You Ge^4*

• ¹School of Public Health, Southeast University, Nanjing, China
• ²Yinzhou District Center for Disease Control and Prevention, Ningbo, China
• ³Xinjiang Medical University, Urumqi, China
• ⁴Department of Infectious Disease, the Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China

Objective This systematic review and meta-analysis aimeds to characterizeinvestigate the epidemiological distribution of HIV-1 viral tropism at diagnosis among people living with HIV (PLWH) and examine its association withcompare baseline CD4⁺ T, between R5 and Non-R5 viral tropism groups among newly diagnosed people living with HIV (PLWH), thereby providing an evidence base for optimizinginforming precision clinical interventions and public health strategies. Method Observational studies reporting viral tropism prevalence and/or baseline CD4⁺ T stratified by tropism were retrieved from PubMed, Web of Science, Embase, and Cochrane Library. A random-effects model was employed for pooled prevalence estimation and mean difference calculation. Heterogeneity was quantified using I² statistics, with subgroup analyses and sensitivity tests to identify heterogeneity sources. Results 27 articles (N = 9372) were included in this study to analyze the distribution of viral tropism, and the prevalence of Non-R5 tropism was 15.68% (95% CI: 12.43-19.24%). Subgroup analysis showed that the prevalence of Non-R5 IDU (27.86%) was significantly higher than that of sexual transmission (15.29%) and other routes (4.62%). The prevalence of Non-R5 tropism in the CRF01_AE subtype group (30.02%) was significantly higher than that of the B subtype (15.33%) and other subtypes (3.44%) (P ≤ 0.05). A comparison of CD4+ T cell counts (17 articles) showed a difference of -97.77 cells/μL that CD4+ T cell counts were significantly lower by 97.99 cells/μL (95% CI: -140.88~-54.67) infor the Non-R5 tropical group relative tocompared with the R5 group. Conclusion Our study findings that PLWH with Non-R5 virus had more severe immune damage at diagnosis compared to PLWH with R5 virus.characterize the distinct distribution patterns of HIV-1 viral tropism at diagnosis and their association with immune impairment severity. This can update the baseline status of patients in clinical practice. since this is a cross-sectional study, fFuture cohort studies should be conducted to verify the relationship between tropism and changes in immunological indicators.expand geographical coverage to validate these patterns and elucidate mechanisms linking tropism evolution with immune reconstitution dynamics, to provide a basis for precise prevention and control based on virological characteristics, to provide a basis for precise prevention and control based on virological characteristics.