Mapping HIV-1 Genetic Diversity and Drug Resistance in Central Africa (2020–2025): A Systematic Review and Meta-Analysis Protocol

Central Africa exhibits the highest genetic diversity of HIV-1 globally, reflecting its role as the region where the virus first emerged. A product of this diversity is the increased prevalence of drug resistance mutations (DRMs), which has been documented in the region, particularly to NRTIs and NNRTIs, highlighting the importance of studying this diversity. This has led to a significant amount of literature being produced on the topic, although it is scattered throughout multiple niche sources, investigates different populations and reports variable outcomes. This review aims to compile this information, offering pooled regional and country-level proportions of subtypes, recombinant forms and individual DRMs, exploring their evolution from 2000 to 2025. To achieve these objectives, a meta-analysis will be performed for each subtype classification and individual DRM, with a subgroup analysis using the country of origin of the samples and a meta-regression analysis using the sample collection date. Methodological quality of the studies will be addressed using a proper tool for systematic reviews of prevalence, heterogeneity using the I² statistic, and publication bias using Egger’s regression test. Finally, a bibliometric analysis will provide an overview of the research landscape in HIV-1 molecular epidemiology in Central Africa and enhance the understanding of subtype distribution and diversity hotspots.