An assessment of the relationship between the World Health Organization HIV drug resistance early warning indicators and HIV drug resistance acquisition.
An assessment of the relationship between the World Health Organization HIV drug resistance early warning indicators and HIV drug resistance acquisition.
复制标题
世界卫生组织HIV耐药预警指标与HIV耐药获得关系的评估。
作者：
St-Jean,M;Harrigan,PR;Sereda,P;Montaner,Jsg;Lima,VD
目的世界卫生组织（WHO）的HIV耐药性（HIV DR）预警指标（EWI）测量与HIV DR预防相关的抗逆转录病毒治疗（ART）现场因素，无需HIV DR实验室检测。我们使用来自加拿大不列颠哥伦比亚省的数据评估了EWI和HIV DR采集之间的关系。MethodsEligible patients were ART-naïve，were ≥ 19 years old，had started ART between 1 January 2000 and 31 December 2012，had ≥ 15 months of follow-up，and were no transmitted HIV DR.对患者的获得性HIV DR进行随访，直至2014年3月31日（最后一次联系日期）或死亡。我们建立了逻辑回归模型来评估各个指标和EWI评分的相关性和预测能力（患者不符合标准的指标数量）（适用于任何类别的HIV DR、拉米夫定（3 TC）/恩曲他滨（FTC）、非核苷逆转录酶抑制剂（NNRTI），核苷逆转录酶抑制剂（NRTIs）或蛋白酶抑制剂（PIs）]）。在我们的预测性逻辑回归模型中，我们观察到获得任何抗逆转录病毒类的HIV DR与EWI评分增加之间的剂量反应关系。曲线下面积为0.848（极好的区分度）。EWI评分为1、2和≥ 3与0时，获得任何类别HIV DR的调整优势比分别为2.30 [95%置信区间（CI）1.21-4.38]、3.35（95% CI：1.86-6.03）和7.26（95%置信区间：4.18-12.61）。结论几种EWI与HIVDR相关并可预测HIVDR，支持世卫组织EWI，将其作为艾滋病毒/艾滋病预防方法的一个组成部分，用于艾滋病毒/艾滋病预防检测不常规或不广泛提供的环境。
ObjectivesThe World Health Organization (WHO)'s HIV drug resistance (HIVDR) early warning indicators (EWIs) measure antiretroviral therapy (ART)‐site factors associated with HIVDR prevention, without HIVDR laboratory testing. We assessed the relationship between EWIs and HIVDR acquisition using data from British Columbia, Canada.MethodsEligible patients were ART‐naïve, were ≥ 19 years old, had initiated ART between 1 January 2000 and 31 December 2012, had ≥ 15 months of follow‐up, and were without transmitted HIVDR. Patients were followed for acquired HIVDR until 31 March 2014, the last contact date, or death. We built logistic regression models to assess the associations and predictive ability of individual indicators and of the EWI Score (the number of indicators for which a patient did not meet the criteria) on HIVDR acquisition (to any class of HIVDR, lamivudine (3TC)/emtricitabine (FTC), nonnucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs) or protease inhibitors (PIs)]).ResultsAll explored EWIs were associated with at least one class of HIVDR, with the exception of ‘ART prescribing practices’. We observed a dose–response relationship between acquiring HIVDR to any antiretroviral class and an increasing EWI score in our predictive logistic regression model. The area under the curve was 0.848 (excellent discrimination). The adjusted odds ratios for acquiring any class of HIVDR for an EWI score of 1, 2 and ≥ 3 versus 0 were 2.30 [95% confidence Interval (CI) 1.21–4.38], 3.35 (95% CI: 1.86–6.03) and 7.26 (95% CI: 4.18–12.61), respectively.ConclusionsSeveral EWIs were associated with and predictive of HIVDR, supporting the WHO EWIs as a component of the HIVDR prevention method in settings where HIVDR testing is not routinely or widely available.