A population-based approach to determine the prevalence of transmitted drug-resistant HIV among recent versus established HIV infections - Results from the Canadian HIV strain and drug resistance surveillance program
A population-based approach to determine the prevalence of transmitted drug-resistant HIV among recent versus established HIV infections - Results from the Canadian HIV strain and drug resistance surveillance program
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DOI：
10.1097/01.qai.0000196666.16616.fe
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发表时间：
2006-05-01
影响因子：
3.6
通讯作者：
Sandstrom, P
中科院分区：
文献类型：
--
作者：
Jayaraman, GC;Archibald, CP;Sandstrom, P
目的：已发表的关于原发性或传播性艾滋病毒耐药性的结果可能存在偏差，因为它们主要来自特定的队列研究或出现症状的高风险个体。在这里，我们提出了一项具有代表性的基于人群的研究结果，研究对象是加拿大新诊断的HIV病例，并比较了新近感染和已确诊感染之间传播性耐药性的流行情况。方法：从2000年至2001年期间新诊断的所有初次接受治疗的HIV阳性个体中获取用于诊断HIV检测的可用存档血清，检测其感染的近期性、HIV-1亚型以及对逆转录酶抑制剂和蛋白酶抑制剂（Pis）易感性降低的突变。使用Organon Teknika Vironostika HIV-1-LS检测确定近期感染。在对pol基因进行全长测序后，利用2004年国际艾滋病协会-美国突变小组确定了耐药突变。使用chi(2)检验和Fisher精确检验检验了近期感染和流行感染之间的耐药概况差异。检查的变量包括性别、诊断年龄、诊断年份、暴露类别、种族和HIV-1亚型。结果：在研究人群中，8.1%有基因型证据表明存在传播性耐药：对核苷类逆转录酶抑制剂耐药4.1%，对非核苷类逆转录酶抑制剂耐药1.4%，对Pis耐药1.5%，对>= 2类药物耐药1%。与已建立的感染相比，近期感染有传播性耐药基因型证据的比例更高（分别为12.2%对6.1%,P = 0.005）。传播性耐药性主要在最近感染的男男性行为的白人男性中发现，但并不局限于这一群体。与2000年相比，2001年诊断出具有耐药性突变的新近感染者比例更高（66.7%对46.6%）。结论：在加拿大，传播性耐药发生在所有3种药物类别和不同人群中。结果表明，近期感染的流行率可能高于已感染的。鉴于传播耐药艾滋病毒对公共卫生的影响，继续开展以人群为基础的耐药监测以指导艾滋病毒感染的最佳预防和治疗是很重要的。
Objectives: Published results on primary or transmitted HIV drug resistance may be biased because they have been largely derived from specific cohort studies or higher risk individuals who present symptomatically. Here, we present results from a representative population-based study of newly diagnosed cases of HIV in Canada and compare the prevalence of transmitted drug resistance between recent and established infections.Methods: Available archived sera taken for the purpose of diagnostic HIV testing from all treatment-naive HIV-positive individuals who were newly diagnosed between 2000 and 2001 were tested for recency of infection, HIV-1 subtype, and mutations conferring reduced susceptibility to reverse transcriptase inhibitors and protease inhibitors (Pis). Recent infections were identified using the Organon Teknika Vironostika HIV-1-LS assay. After full-length sequencing of the pol gene, drug resistance mutations were identified using the 2004 International AIDS Society-USA mutations panel. Differences in drug resistance profiles between recent and prevalent infections were examined using the chi(2) test and the Fisher exact test. The variables examined included gender, age at diagnosis, year of diagnosis, exposure category, ethnicity, and HIV-1 subtype.Results: Among the study population, 8.1% had genotypic evidence of transmitted drug resistance: 4.1% against nucleoside reverse transcriptase inhibitors, 1.4% against nonnucleoside reverse transcriptase inhibitors, 1.5% against Pis, and 1% against >= 2 classes of drugs. A higher proportion of recent infections had genotypic evidence of transmitted drug resistance when compared with established infections (12.2% vs. 6.1%, respectively; P = 0.005). Transmitted drug resistance was identified mainly among recently infected Caucasian men who have sex with men but it was not limited to this group. Compared with the year 2000, a higher proportion of recently infected individuals with resistance-conferring mutations were diagnosed during the year 2001 (66.7% vs. 46.6%).Conclusions: In Canada, transmitted drug resistance is occurring within all 3 drug classes and across different population groups. The results suggest that the prevalence rates may be higher among recent versus established infections. Given the public health implications of transmitting drug-resistant HIV, it is important to continue population-based drug resistance surveillance to guide optimum prevention and treatment of HIV infection.