Viremia and drug resistance among HIV-1 patients on antiretroviral treatment: a cross-sectional study in Soweto, South Africa.
Viremia and drug resistance among HIV-1 patients on antiretroviral treatment: a cross-sectional study in Soweto, South Africa.
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DOI：
10.1097/qad.0b013e32833a097b
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发表时间：
2010-07-17
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影响因子：
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通讯作者：
Morris L
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作者：
El-Khatib Z;Ekstrom AM;Ledwaba J;Mohapi L;Laher F;Karstaedt A;Charalambous S;Petzold M;Katzenstein D;Morris L
我们评估了南非长期接受抗逆转录病毒治疗（ART）的患者中病毒血症和耐药（DR）的危险因素。2008年，我们在接受ART ≥12个月的患者中进行了一项横断面研究。对病毒载量>400 RNA拷贝/ml的个体进行基因型抗性测试。多元logistic回归分析用于评估相关性。在998名受试者中，75%为女性，中位年龄为41岁。大多数（64%）接受治疗超过3年。病毒血症的患病率为14%（n=139）;一线（即基于NNRTI的方案）为12%（102/883），二线（即基于PI的方案）ART为33%（37/115）。在病毒血症患者中，78%有DR突变。对于NRTI、NNRTI和PI，一线治疗失败的突变发生率分别为64%、81%和2%，二线治疗失败的突变发生率分别为29%、54%和6%。M184 V/I、K103 N和V106 A/M是最常见的突变。与一线治疗病毒血症相关的重要危险因素包括合并结核治疗（OR 6.4，2.2-18.8，p<0.01）和近期依从性差史（OR 2.7，1.3-5.6，p=0.01）。在二线治疗失败者中，去公共诊所（OR 4.6，1.8-11.3，p<0.01）和家里没有冰箱（OR 6.7，1.2-37.5，p=0.03）是病毒学失败的危险因素。病毒治疗失败的风险因素依赖于线方案。二线抗逆转录病毒疗法接受者有较高的病毒血症率，尽管很少有PI DR突变。维持有效病毒学抑制的措施应包括增加依从性咨询，注意合并结核病治疗和二线ART方案的热稳定制剂。
We assessed risk factors for viremia and drug resistance (DR) among long-term recipients of antiretroviral therapy (ART) in South Africa. In 2008, we conducted a cross-sectional study among patients receiving ART for ≥12 months. Genotypic resistance testing was performed on individuals with a viral load >400 RNA copies/ml. Multiple logistic regression analysis was used to assess associations. Of 998 subjects, 75% were women with a median age of 41. Most (64%) had been on treatment for >3 years. The prevalence of viremia was 14% (n=139); 12% (102/883) on first-line (i.e. NNRTI based regimen) and 33% (37/115) on second-line (i.e. PI based regimen) ART. Of viremic patients, 78% had DR mutations. For NRTIs, NNRTIs and PIs the prevalence of mutations was 64%, 81% and 2% among first-line and 29%, 54% and 6% among second-line failures respectively. M184V/I, K103N and V106A/M were the most common mutations. Significant risk factors associated with viremia on first-line included concurrent tuberculosis treatment (OR 6.4, 2.2-18.8, p<0.01) and a recent history of poor adherence (OR 2.7, 1.3-5.6, p=0.01). Among second-line failures, attending a public clinic (OR 4.6, 1.8-11.3, p<0.01) and not having a refrigerator at home (OR 6.7, 1.2-37.5, p=0.03) were risk factors for virological failure. Risk factors for viral failure were line-regimen dependent. Second-line ART recipients had a higher rate of viremia, albeit with infrequent PI DR mutations. Measures to maintain effective virologic suppression should include increased adherence counseling, attention to concomitant tuberculosis treatment and heat-stable formulations of second-line ART regimens.