HIV-1 virologic failure and acquired drug resistance among first-line antiretroviral experienced adults at a rural HIV clinic in coastal Kenya: a cross-sectional study.
HIV-1 virologic failure and acquired drug resistance among first-line antiretroviral experienced adults at a rural HIV clinic in coastal Kenya: a cross-sectional study.
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DOI：
10.1186/1742-6405-11-9
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发表时间：
2014-01-23
影响因子：
2.2
通讯作者：
Berkley JA
中科院分区：
文献类型：
--
作者：
Hassan AS;Nabwera HM;Mwaringa SM;Obonyo CA;Sanders EJ;Rinke de Wit TF;Cane PA;Berkley JA
在撒哈拉以南非洲，越来越多的人接受抗逆转录病毒治疗，导致艾滋病毒相关的发病率和死亡率下降。然而，病毒学失败（VF）和获得性耐药（ADR）可能会对这些收益产生负面影响。本研究描述了肯尼亚沿海地区一家农村艾滋病诊所一线抗逆转录病毒治疗经验丰富的成年人中HIV-1 VF和ADR的患病率和相关性。在2008年11月至2011年3月期间，横断面招募了接受一线抗逆转录病毒治疗≥6个月的艾滋病毒感染成人。主要结局为VF，定义为一次性血浆病毒载量≥400拷贝/ml。次要结局是ADR，定义为存在耐药相关突变。分别采用Logistic回归和Fishers精确检验描述VF和ADR的相关性。在232名接受ART治疗的合格参与者中，中位持续时间为13.9个月，57名（24.6% [95% CI：19.2 - 30.6]）患有VF。55个病毒血症样本成功扩增和测序。其中，29例（52.7% [95% CI：38.8 - 66.3]）至少有1例ADR，25例样本有双重耐药突变。最常见的ADR突变为M184 V（n = 24）、K103 N/S（n = 14）和Y181 C/Y/I/V（n = 8）。在55份成功扩增的病毒血症样本中，有26份（47.3%）未检测到任何耐药突变。年轻（15-34岁vs. ≥35岁：校正比值比[95% CI]，p值：0.3 [0.1-0.6]，p = 0.002）和依从性不满意（<95% vs. ≥95%：3.0 [1.5-6.5]，p = 0.003）与VF密切相关。年龄小、依从性差和病毒载量高也是ADR的强相关因素。在年轻患者和依从性不满意的患者中观察到高水平的VF和ADR。在肯尼亚沿海地区，应优先考虑对青少年友好的ART举措和加强依从性支持。为了防止不必要/过早的转换，应考虑对确诊VF的患者进行有针对性的HIV耐药性检测。
An increasing number of people on antiretroviral therapy (ART) in sub-Saharan Africa has led to declines in HIV related morbidity and mortality. However, virologic failure (VF) and acquired drug resistance (ADR) may negatively affect these gains. This study describes the prevalence and correlates of HIV-1 VF and ADR among first-line ART experienced adults at a rural HIV clinic in Coastal Kenya. HIV-infected adults on first-line ART for ≥6 months were cross-sectionally recruited between November 2008 and March 2011. The primary outcome was VF, defined as a one-off plasma viral load of ≥400 copies/ml. The secondary outcome was ADR, defined as the presence of resistance associated mutations. Logistic regression and Fishers exact test were used to describe correlates of VF and ADR respectively. Of the 232 eligible participants on ART over a median duration of 13.9 months, 57 (24.6% [95% CI: 19.2 – 30.6]) had VF. Fifty-five viraemic samples were successfully amplified and sequenced. Of these, 29 (52.7% [95% CI: 38.8 – 66.3]) had at least one ADR, with 25 samples having dual-class resistance mutations. The most prevalent ADR mutations were the M184V (n = 24), K103N/S (n = 14) and Y181C/Y/I/V (n = 8). Twenty-six of the 55 successfully amplified viraemic samples (47.3%) did not have any detectable resistance mutation. Younger age (15–34 vs. ≥35 years: adjusted odd ratios [95% CI], p-value: 0.3 [0.1–0.6], p = 0.002) and unsatisfactory adherence (<95% vs. ≥95%: 3.0 [1.5–6.5], p = 0.003) were strong correlates of VF. Younger age, unsatisfactory adherence and high viral load were also strong correlates of ADR. High levels of VF and ADR were observed in younger patients and those with unsatisfactory adherence. Youth-friendly ART initiatives and strengthened adherence support should be prioritized in this Coastal Kenyan setting. To prevent unnecessary/premature switches, targeted HIV drug resistance testing for patients with confirmed VF should be considered.
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6.4
作者：
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