Scale-up of antiretroviral treatment in sub-Saharan Africa is accompanied by increasing HIV-1 drug resistance mutations in drug-naive patients
Scale-up of antiretroviral treatment in sub-Saharan Africa is accompanied by increasing HIV-1 drug resistance mutations in drug-naive patients
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DOI：
10.1097/qad.0b013e32834bbbe9
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发表时间：
2011-11-13
期刊：
影响因子：
3.8
通讯作者：
Peeters, Martine
中科院分区：
文献类型：
--
作者：
Aghokeng, Avelin F.;Kouanfack, Charles;Peeters, Martine
目的：评价世界卫生组织定义的传播性HIV-1耐药突变(DRM)在喀麦隆抗逆转录病毒治疗(ART)初治HIV-1感染者中的频率和随时间的进展。设计：我们分析了1996-2007年间在喀麦隆城乡连续招募的369名未接受抗逆转录病毒治疗(ART)的HIV-1耐药突变数据。方法：采用血浆样本对HIV-1耐药基因进行分型，并使用2009年WHO-DRM列表进行监测DRM。结果：我们在首都雅温得观察到，随着时间的推移，DRM的患病率不断上升：1996-1999年，0.0%(61名参与者中没有一人)；2001年为1.9%(53名参与者中的一名)；2002年为4.1%(49名参与者中的两名)；2007年为12.3%(81名参与者中的10名)。在最近实施ART项目的农村地区，我们在2006-2007年招募的125名ART天真个体中有6人(4.8%)发现了DRM。在这两个地区发现的DRM包括对蛋白酶抑制剂、核苷类逆转录酶抑制剂(NRTI)和非NRTI的耐药性突变，这些突变可能会削弱现有一线和二线治疗的疗效。结论：这份报告显示，在较早引入抗逆转录病毒药物的地区，传播的DRM有所增加，但不能完全排除其他因素，如自然病毒多态性和通过接触抗逆转录病毒获得的DRM。需要进一步的监测，以确认这一演变，并向公共卫生政策通报适当的行动，以帮助限制抗药性艾滋病毒的选择和传播，同时扩大发展中国家获得抗逆转录病毒药物的机会。(C)2011年Wolters Kluwer Health垂直酒吧Lippincott Williams&Wilkins
Objectives: To evaluate the frequency and progression over time of the WHO-defined transmitted HIV-1 drug resistance mutations (DRMs) among antiretroviral treatment (ART)-naive HIV-1-infected patients in Cameroon.Design: We analyzed HIV-1 DRM data generated from 369 ART-naive individuals consecutively recruited between 1996 and 2007 in urban and rural areas in Cameroon.Methods: HIV-1 drug resistance genotyping was performed in the pol gene using plasma samples and surveillance DRMs were identified using the 2009 WHO-DRM list.Results: We observed in Yaounde, the capital city, an increasing prevalence of DRMs over time: 0.0% (none of 61 participants) in 1996-1999; 1.9% (one of 53 participants) in 2001; 4.1% (two of 49 participants) in 2002; and 12.3% (10 of 81 participants) in 2007. In the rural areas with more recently implemented ART programs, we found DRMs in six of 125 (4.8%) ART-naive individuals recruited in 2006-2007. DRMs identified in both areas included resistance mutations to protease inhibitors, nucleoside reverse transcriptase inhibitors (NRTIs) and non-NRTIs (NNRTIs) that might impair the efficacy of available first-line and second-line treatments.Conclusion: This report showed an increase in transmitted DRMs in areas where antiretroviral drugs were introduced earlier, although other factors such as natural viral polymorphisms and acquired DRMs through exposure to antiretroviral cannot be totally excluded. Further surveillances are needed to confirm this evolution and inform public health policies on adequate actions to help limit the selection and transmission of drug-resistant HIV, while scaling up access to ART in developing countries. (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins