Determinants of virological failure and antiretroviral drug resistance in Mozambique
Determinants of virological failure and antiretroviral drug resistance in Mozambique
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DOI：
10.1093/jac/dkv143
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发表时间：
2015-09-01
影响因子：
5.2
通讯作者：
Paredes, Roger
中科院分区：
文献类型：
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作者：
Ruperez, Maria;Pou, Christian;Paredes, Roger
目的：本研究的目的是为公共卫生行动提供信息，以限制莫桑比克的一线抗逆转录病毒治疗失败和艾滋病毒耐药性。方法：这是一项横断面研究。接受一线抗逆转录病毒治疗至少一年的 HIV-1 感染成年人在莫桑比克南部半农村地区的 Manhic 地区医院进行例行就诊，对这些患者的临床、社会人口、治疗、免疫学和病毒学特征进行了评估。该医院位于莫桑比克南部半农村地区，没有 HIV-1 RNA 监测。使用多变量逻辑回归确定与 HIV-1 RNA >= 1000 拷贝/mL 和 HIV 耐药性相关的因素。 结果：该研究纳入了 334 名接受一线 ART 治疗的成年人，平均时间为 3 年，其中 65% (214/332) 的病毒血症受到抑制，11% (37/332) 的病毒血症水平较低（HIV-1 RNA 150-999 拷贝/mL）， 24% (81/332) 存在明显的病毒学失败（HIV-1 RNA >= 1000 拷贝/mL）。 89% 的病毒学失败受试者中检测到 HIV 耐药性，但低水平病毒血症受试者中没有检测到 HIV 耐药性。年龄越小[OR = 每增加一年0.97 (95% CI = 0.94-1.00)，P = 0.039]，在WHO III/IV期开始ART [OR = 2.10 (95% CI = 1.23-3.57)，P = 0.003] 和低ART依从性[OR = 2.69 (95% CI = 1.39-5.19），P = 0.003]与病毒学失败相关。接受 ART 的时间延长[OR = 1.55（每增加一年）（95% CI = 1.00-2.43），P = 0.052] 和文盲 [OR = 0.24（95% CI = 0.07-0.89），P = 0.033] 与 HIV 耐药性相关。与 HIV-1 RNA 相比，临床医生根据临床和免疫学结果对 ART 失败的判断灵敏度仅为 29%，每 4.5 名受试者中就有 1 人误诊。结论：莫桑比克的公共卫生规划应侧重于早期 HIV 诊断、早期 ART 启动和依从性支持。病毒学监测极大地改善了 ART 失败的诊断，从而更好地利用资源。
Objectives: The objective of this study was to inform public health actions to limit first-line ART failure and HIV drug resistance in Mozambique.Methods: This was a cross-sectional study. HIV-1-infected adults on first-line ART for at least 1 year attending routine visits in the Manhic, a District Hospital, in a semi-rural area in southern Mozambique with no HIV-1 RNA monitoring available, were evaluated for clinical, socio-demographic, therapeutic, immunological and virological characteristics. Factors associated with HIV-1 RNA >= 1000 copies/mL and HIV drug resistance were determined using multivariate logistic regression.Results: The study included 334 adults on first-line ART for a median of 3 years, of which 65% (214/332) had suppressed viraemia, 11% (37/332) had low-level viraemia (HIV-1 RNA 150-999 copies/mL) and 24% (81/332) had overt virological failure (HIV-1 RNA >= 1000 copies/mL). HIV drug resistance was detected in 89% of subjects with virological failure, but in none with low-level viraemia. Younger age [OR = 0.97 per additional year (95% CI = 0.94-1.00), P = 0.039], ART initiation at WHO stage III/IV [OR = 2.10 (95% CI = 1.23-3.57), P = 0.003] and low ART adherence [OR = 2.69 (95% CI = 1.39-5.19), P = 0.003] were associated with virological failure. Longer time on ART [OR = 1.55 per additional year (95% CI = 1.00-2.43), P = 0.052] and illiteracy [OR = 0.24 (95% CI = 0.07-0.89), P = 0.033] were associated with HIV drug resistance. Compared with HIV-1 RNA, clinician's judgement of ART failure, based on clinical and immunological outcomes, only achieved 29% sensitivity and misdiagnosed 1 out of every 4.5 subjects.Conclusions: Public health programmes in Mozambique should focus on early HIV diagnosis, early ART initiation and adherence support. Virological monitoring drastically improves the diagnosis of ART failure, enabling a better use of resources.