Low Prevalence of Transmitted HIV Type 1 Drug Resistance Among Antiretroviral-Naive Adults in a Rural HIV Clinic in Kenya
Low Prevalence of Transmitted HIV Type 1 Drug Resistance Among Antiretroviral-Naive Adults in a Rural HIV Clinic in Kenya
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DOI：
10.1089/aid.2012.0167
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发表时间：
2013-01-01
影响因子：
1.5
通讯作者：
Berkley, James A.
中科院分区：
文献类型：
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作者：
Hassan, Amin S.;Mwaringa, Shalton M.;Berkley, James A.
撒哈拉以南非洲（sSA）许多地区此前曾报告过低水平的HIV-1传播耐药性（TDR）。然而，最近的数据，主要来自城市环境，表明艾滋病毒-1 TDR的流行率上升。我们的目的是确定TDR突变的流行率HIV-1感染，抗逆转录病毒（ARV）初治的成年人登记在肯尼亚的农村艾滋病诊所的照顾。2008年7月至2010年6月期间进行了两项横断面研究。在艾滋病毒诊断后和开始抗逆转录病毒治疗前，使用了未接受过抗逆转录病毒治疗的成年人（>15岁）在登记接受治疗时的血浆样本。扩增并测序了含有蛋白酶和部分逆转录酶基因的病毒pol亚基因组区域的一部分。使用斯坦福大学HIV耐药数据库和WHO耐药菌株监测清单鉴定和解释TDR突变。总体而言，成功扩增和测序了182名ARV初治成人[平均年龄（95%CI）：34.9（33.3-36.4）岁]的样本。确定了核苷逆转录酶抑制剂[n = 1（T215 D）]和蛋白酶抑制剂[n = 1（M46 L）]的两种TDR突变，总体TDR患病率为1.1%（95%CI：0.1-3.9）。尽管有报告称，在南非的一些城市环境中，HIV-1 TDR的患病率有所增加，但我们报告称，肯尼亚沿海地区一家农村艾滋病诊所的HIV-1 TDR患病率低于5%。需要继续进行更广泛的监测来监测sSA中TDR的程度。
Low levels of HIV-1 transmitted drug resistance (TDR) have previously been reported from many parts of sub-Saharan Africa (sSA). However, recent data, mostly from urban settings, suggest an increase in the prevalence of HIV-1 TDR. Our objective was to determine the prevalence of TDR mutations among HIV-1-infected, antiretroviral (ARV)-naive adults enrolling for care in a rural HIV clinic in Kenya. Two cross-sectional studies were carried out between July 2008 and June 2010. Plasma samples from ARV-naive adults (>15 years old) at the time of registering for care after HIV diagnosis and before starting ARVs were used. A portion of the pol subgenomic region of the virus containing the protease and part of the reverse transcriptase genes was amplified and sequenced. TDR mutations were identified and interpreted using the Stanford HIV drug resistance database and the WHO list for surveillance of drug resistance strains. Overall, samples from 182 ARV-naive adults [ mean age (95% CI): 34.9 (33.3-36.4) years] were successfully amplified and sequenced. Two TDR mutations to nucleoside reverse transcriptase inhibitors [n = 1 (T215D)] and protease inhibitors [n = 1 (M46L)] were identified, giving an overall TDR prevalence of 1.1% (95% CI: 0.1-3.9). Despite reports of an increase in the prevalence of HIV-1 TDR in some urban settings in sSA, we report a prevalence of HIV-1 TDR of less than 5% at a rural HIV clinic in coastal Kenya. Continued broader surveillance is needed to monitor the extent of TDR in sSA.