Resistance and viral subtypes: how important are the differences and why do they occur?
Resistance and viral subtypes: how important are the differences and why do they occur?
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DOI：
10.1097/coh.0b013e32801682e2
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发表时间：
2007-03-01
影响因子：
4.1
通讯作者：
Brenner, Bluma G.
中科院分区：
文献类型：
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作者：
Brenner, Bluma G.
回顾的目的全球HIV-1大流行已经发展到包括11种亚型和34种循环重组形式。然而，我们对HIV-1抗逆转录病毒药物反应和紧急耐药性的了解仅限于在欧洲和北美流行的B亚型感染，几乎没有关于占全球流行病约90%的非B亚型的比较信息。本综述总结了过去一年中的出版物，强调亚型间的差异影响病毒对抗逆转录病毒药物的敏感性和紧急耐药。最近的findingsCumulative结果从临床研究表明，抗逆转录病毒治疗将是有益的，在整体治疗非B亚型感染，并导致耐药概况相媲美的亚型B感染。然而，Pol区域中10-15%的序列多样性有助于对特定核苷和非核苷类似物以及蛋白酶抑制剂的反应的亚型间差异。对于特定的非B亚型，识别出不同的特征突变和突变途径。亚型对临床结果和解释算法的影响described.SummaryUnderstanding亚型间的耐药性差异是重要的，在资源匮乏的环境中优化治疗策略。希望这可能有助于设计预防方法，以防止HIV-1的横向和纵向传播。
Purpose of reviewThe global HIV-1 pandemic has evolved to include 11 subtypes and 34 circulating recombinant forms. Our knowledge of HIV-1 response to antiretroviral drugs and emergent drug resistance has, however, been limited to subtype B infections circulating in Europe and North America, with little comparative information on non-B subtypes representing approximately 90% of worldwide epidemics. This review summarizes publications in the past year that highlight intersubtype differences influencing viral susceptibility to antiretroviral drugs and emergent drug resistance.Recent findingsCumulative findings from clinical studies suggest that antiretroviral therapy will be of benefit in the overall treatment of non-B subtype infections, and result in drug-resistance profiles comparable to those observed for subtype B infections. Nevertheless, the 10-15% sequence diversity in the Pol region contributes to intersubtype differences in response to particular nucleoside and non-nucleoside analogues, as well as protease inhibitors. Distinct signature mutations and mutational pathways are identified for specific non-B subtypes. The implications of subtype on clinical outcome and interpretative algorithms are described.SummaryUnderstanding intersubtype differences in drug resistance is important in optimizing treatment strategies in resource-poor settings. Hopefully, this may assist in the design of prophylactic approaches to prevent HIV-1 horizontal and vertical HIV-1 transmission.