Systematic review of HIV drug resistance in Southeast Asia.
Systematic review of HIV drug resistance in Southeast Asia.
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发表时间：
2013-07
期刊：
影响因子：
2.2
通讯作者：
A. Trotter;Steven Y Hong;P. Srikantiah;I. Abeyewickreme;S. Bertagnolio;M. Jordan
中科院分区：
文献类型：
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作者：
A. Trotter;Steven Y Hong;P. Srikantiah;I. Abeyewickreme;S. Bertagnolio;M. Jordan
2010年，世界卫生组织东南亚区域有350万艾滋病毒感染者，使该区域成为仅次于非洲的艾滋病毒最大负担。抗逆转录病毒疗法的推广导致到2010年底有717 000多人从中受益。对2000年至2011年期间发表的SEAR中的HIV耐药性研究进行了系统综述。在最近感染患者中进行的10项传播艾滋病毒耐药性研究中，除两项外，所有研究都报告了低水平（< 5%）的传播耐药性。在23项关于开始抗逆转录病毒治疗的治疗前人群中艾滋病毒耐药性的研究中，3项报告了中度（5-15%）艾滋病毒耐药性，20项报告了低度耐药性。在17项获得性HIV耐药研究中，病毒学失败者中核苷类逆转录酶抑制剂和非核苷类逆转录酶抑制剂耐药水平分别为52 - 92%和43 - 100%。总体而言，本综述中包含的数据表明，目前推荐的一线和二线治疗方案适用于所研究的队列。然而，只有11个东南亚区域国家中的两个国家提供了数据，研究主要考察了城市人口。结果不太可能代表该区域。研究缺乏标准化的方法，这极大地限制了数据的可比性及其在公共卫生和抗逆转录病毒治疗计划规划中的应用。应大力鼓励东南亚地区国家开展常规、标准化和具有全国代表性的艾滋病毒耐药性监测，以最好地表征人群水平的艾滋病毒耐药性。国家一级的艾滋病毒耐药性监测数据可用于优化艾滋病毒护理和治疗的提供，尽量减少人口一级艾滋病毒耐药性的出现，从而提高现有一线和二线抗逆转录病毒治疗方案的长期疗效和持久性。
In 2010, 3.5 million people were living with HIV in the World Health Organization Southeast Asia Region (SEAR), giving this region the greatest burden of HIV after Africa. Scale-up of antiretroviral therapy has resulted in over 717,000 benefitting from it by the end of 2010. A systematic review of studies of HIV drug resistance in the SEAR published between 2000 and 2011 was performed. Of 10 studies of transmitted HIV drug resistance in recently infected patients, all but two reported low levels (< 5%) of transmitted resistance. Of 23 studies of HIV drug resistance in pretreatment populations initiating antiretroviral therapy, three reported moderate levels (5-15%) of HIV drug resistance and 20 reported low levels. Amongst 17 studies of acquired HIV drug resistance, levels of nucleoside reverse transcriptase inhibitor and nonnucleoside reverse transcriptase inhibitor resistance ranged from 52 to 92% and 43 to 100%, respectively, amongst those with virological failure. Overall, data included in this review suggest that currently recommended first- and second-line regimens are appropriate for the cohorts studied. However, data were only available from two of 11 Southeast Asia Region countries and studies largely examined urban populations. Results are unlikely to be representative of the region. Studies lacked standardized methods, which greatly limits comparability of data and their use for public health and antiretroviral therapy program planning. Routine, standardized, and nationally representative HIV drug resistance surveillance should be strongly encouraged in the Southeast Asia Region countries to best characterize population-level HIV drug resistance. National-level HIV drug resistance surveillance data may be used to optimize delivery of HIV care and treatment and minimize emergence of population-level HIV drug resistance, thus promoting the long-term efficacy and durability of available first- and second-line antiretroviral therapy regimens.