Prevalence of HIV drug resistance in Nigeria: results from a cross-sectional, population-based survey of Nigerian adults with unsuppressed viral load
Prevalence of HIV drug resistance in Nigeria: results from a cross-sectional, population-based survey of Nigerian adults with unsuppressed viral load
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DOI：
10.1097/qad.0000000000003413
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发表时间：
2023-02-01
期刊：
影响因子：
3.8
通讯作者：
Stafford, Kristen A.
中科院分区：
文献类型：
--
作者：
Aliyu, Gambo G.;Lawton, Jonathan G.;Stafford, Kristen A.
背景：艾滋病病毒（HIV）耐药性监测是监测对疫情控制进展构成威胁的重要工具。需要了解尼日利亚全国层面的HIV耐药性特征，以便为临床决策和人群层面的HIV政策策略提供依据。本研究利用从尼日利亚艾滋病指标和影响调查（NAIIS）中获取的数据来描述尼日利亚HIV耐药性的流行情况和分布。
方法：2018年，NAIIS是一项在尼日利亚全国范围内基于家庭的横断面调查。该调查旨在从具有全国代表性的样本中提供HIV感染率及相关健康指标的估计值。研究人群包括年龄在15 - 64岁之间、HIV检测呈阳性、病毒载量至少为1000拷贝/毫升且有可用的HIV耐药基因型的参与者。对HIV分离株进行基因分型以检测耐药突变。使用加权多变量逻辑回归模型确定与HIV耐药性相关的研究参与者的个体特征。
结果：在1355名有可用HIV基因型的受访者中，293人（19%）有耐药突变（DRMs）的证据，这些突变对至少一种抗逆转录病毒药物产生耐药性。观察到的大多数耐药突变对非核苷类逆转录酶抑制剂（NNRTIs）（17.6%）和核苷类逆转录酶抑制剂（NRTIs）（11.2%）产生耐药性。HIV耐药性与有抗逆转录病毒治疗（ART）经验、ART治疗持续时间较长以及CD4⁺细胞计数较低有关，但与社会人口学特征无关。
结论：尼日利亚人群层面的耐药突变流行率与成熟的HIV治疗环境中的预期相符。继续推出以多替拉韦为基础的治疗方案应能减轻非核苷类逆转录酶抑制剂耐药性对人群病毒载量抑制以及疫情控制进展的影响。
Background:HIV drug resistance (HIVDR) surveillance is an important tool to monitor threats to progress towards epidemic control. The characterization of HIVDR in Nigeria at the national level is needed to inform both clinical decisions and population-level HIV policy strategies. This study uses data obtained from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) to describe the prevalence and distribution of HIVDR in Nigeria.Methods:NAIIS was a cross-sectional, population-based survey of households throughout Nigeria in 2018. NAIIS was designed to provide estimates of HIV prevalence and related health indicators from a nationally representative sample. The study population included participants aged 15-64 years who tested positive for HIV, had a viral load at least 1000 copies/ml, and had available HIV drug resistance genotypes. HIV isolates were genotyped to detect drug resistance mutations. Individual characteristics of study participants associated with HIVDR were identified using a weighted multivariable logistic regression model.Results:Of 1355 respondents with available HIV genotypes, 293 (19%) had evidence of drug-resistant mutations (DRMs) that conferred resistance to at least one antiretroviral drug. The majority of DRMs observed conferred resistance to NNRTIs (17.6%) and NRTIs (11.2%). HIVDR was associated with being ART-experienced, longer duration on ART, and lower CD4(+) count but not sociodemographic characteristics.Conclusion:The population level DRM prevalence in Nigeria was consistent with what would be expected in a mature HIV treatment landscape. The continued roll out of dolutegravir-anchored regimens should mitigate the impact of NNRTI resistance on population viral load suppression and progress towards epidemic control.