Prevalence of pretreatment HIV drug resistance in West African and Southeast Asian countries
Prevalence of pretreatment HIV drug resistance in West African and Southeast Asian countries
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DOI：
10.1093/jac/dky443
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发表时间：
2019-02-01
影响因子：
5.2
通讯作者：
Ton Tran
中科院分区：
文献类型：
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作者：
Ngo-Giang-Huong, Nicole;Huynh, Thu H. K.;Ton Tran
背景：随着世卫组织建议检测和立即治疗艾滋病毒阳性个体，发展中国家的抗逆转录病毒治疗进入了一个新时代。预处理HIV耐药（PDR）的高频率可能损害抗逆转录病毒治疗的疗效。我们的研究提供了西非（布基纳法索、喀麦隆、科特迪瓦、马里和多哥）和东南亚（泰国和越南）七个国家PDR的最新估计。方法：符合条件的研究参与者为成人ART发起者，于2015年12月至2016年11月在每个国家的主要ART诊所招募。对所有标本进行艾滋病毒耐药性（HIVDR）测试，并使用斯坦福算法进行解释。结果：总共招募了1153名参与者，产生了1020nt序列。总体而言，所有发起者的PDR频率为15.9% (95% CI: 13.8%-18.3%)，布基纳法索和泰国分别为9.6%和10.2%，越南为14.7%，马里为15.4%，科特迪瓦为16.5%，喀麦隆为19.3%，多哥为24.6%。NNRTI耐药突变发生率为12%；NRTI和PI PDR患病率分别为4%和3%。结论：我们的研究表明，在大多数国家，PDR超过10%，有必要进行具有全国代表性的调查来证实这一趋势。与此同时，应紧急采取行动防止耐药，包括从nnrti过渡到更强效的药物类别。
Background: ART in the developing world has moved to a new era with the WHO recommendation to test and immediately treat HIV-positive individuals. A high frequency of pretreatment HIV drug resistance (PDR) can compromise ART efficacy. Our study presents updated estimates of PDR in seven countries from West Africa (Burkina Faso, Cameroon, Cate d'Ivoire, Mali and Togo) and Southeast Asia (Thailand and Vietnam).Methods: Eligible study participants were adult ART initiators, recruited from December 2015 to November 2016 in major ART clinics in each country. HIV drug resistance (HIVDR) tests were performed for all specimens and interpretation was done using the Stanford algorithm.Results: Overall, 1153 participants were recruited and 1020 nt sequences were generated. PDR frequency among all initiators was 15.9% (95% CI: 13.8%-18.3%) overall, ranging from 9.6% and 10.2% in Burkina Faso and Thailand, respectively, 14.7% in Vietnam, 15.4% in Mali, 16.5% in Cote d'Ivoire and 19.3% in Cameroon, to 24.6% in Togo. The prevalence of NNRTI resistance mutations was 12%; NRTI and PI PDR prevalences were 4% and 3%, respectively.Conclusions: Our study shows that in most countries PDR exceeded 10%, warranting the conduct of nationally representative surveys to confirm this trend. In the meantime, actions to prevent drug resistance, including transition from NNRTIs to more robust drug classes should be urgently implemented.