Prevalence of transmitted HIV-1 antiretroviral resistance among patients initiating antiretroviral therapy in Brazil: a surveillance study using dried blood spots
Prevalence of transmitted HIV-1 antiretroviral resistance among patients initiating antiretroviral therapy in Brazil: a surveillance study using dried blood spots
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DOI：
10.7448/ias.17.1.19042
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发表时间：
2014-09-22
影响因子：
6
通讯作者：
Diaz, Ricardo S.
中科院分区：
文献类型：
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作者：
de Moraes Soares, Celina M. P.;Vergara, Tania R. C.;Diaz, Ricardo S.
简介：在巴西，抗逆转录病毒药物的使用很普遍：目前有超过 260,000 人正在接受治疗。我们针对未接受过抗逆转录病毒治疗且根据当地指南开始抗逆转录病毒治疗 (ART) 的个体进行了一项调查。本次调查覆盖巴西五个地区。方法：采用世界卫生组织的艾滋病毒阈值调查方法（HIV-THS），从代表巴西所有宏观区域的七个人口稠密城市中选取受试者。干血斑 (DBS) 收集在 SS903 采集卡上，并在室温下通过普通邮件运输至单一中心实验室进行基因分型。 结果：我们分析了 329 名开始高效抗逆转录病毒治疗 (HAART) 的个体的样本，其中 39 名 (11.8%) 患有传播耐药性 (TDR)。平均 CD4+ T 细胞计数为 253 个细胞/μL，平均病毒载量为 142,044 个拷贝/mL。地区耐药率东北地区为17.0%，东南地区为12.8%，中部地区为10.6%，北方地区为8.5%，南方地区为8.5%。核苷逆转录酶抑制剂的抑制剂特异性 TDR 发生率为 6.9%，非核苷逆转录酶抑制剂为 4.9%，蛋白酶抑制剂为 3.9%； 3.6% 的人对不止一类抑制剂表现出耐药性。总体而言，南方 C 亚型患病率较高，北方 F 亚型患病率较高。在收集的 DBS 样本中，9.3% 未能提供可靠的结果。 讨论：我们在 HIV 疾病进展的个体中发现了不同的 TDR 患病率，从中到高水平不等，因此意味着在巴西开始 ART 之前进行耐药性检测可能是有效的。我们的结果还表明，使用 DBS 对于在资源有限和远程环境中提供测试可能特别有价值。
Introduction: In Brazil, the use of antiretrovirals is widespread: more than 260,000 individuals are currently undergoing treatment. We conducted a survey targeting antiretroviral-naive individuals who were initiating antiretroviral therapy (ART) according to local guidelines. This survey covered five Brazilian regions.Methods: The HIV Threshold Survey methodology (HIV-THS) of the World Health Organization was utilized, and subjects were selected from seven highly populated cities representative of all Brazilian macro-regions. Dried blood spots (DBS) were collected on SS903 collection cards and were transported by regular mail at room temperature to a single central laboratory for genotyping.Results: We analysed samples from 329 individuals initiating highly active antiretroviral therapy (HAART), 39 (11.8%) of whom were harbouring transmitted drug resistance (TDR). The mean CD4+ T cell count was 253 cells/mu L, and the mean viral load was 142,044 copies/mL. The regional prevalence of resistance was 17.0% in the Northeast, 12.8% in the Southeast, 10.6% in the Central region, 8.5% in the North and 8.5% in the South. The inhibitor-specific TDR prevalence was 6.9% for nucleoside reverse transcriptase inhibitors, 4.9% for non-nucleoside reverse transcriptase inhibitors and 3.9% for protease inhibitors; 3.6% of individuals presented resistance to more than one class of inhibitors. Overall, there were trends towards higher prevalences of subtype C towards the South and subtype F towards the North. Of the DBS samples collected, 9.3% failed to provide reliable results.Discussion: We identified variable TDR prevalence, ranging from intermediate to high levels, among individuals in whom HIV disease progressed, thus implying that resistance testing before initiating ART could be effective in Brazil. Our results also indicate that the use of DBS might be especially valuable for providing access to testing in resource-limited and remote settings.