Evidence of a decline in transmitted HIV-1 drug resistance in the United Kingdom
Evidence of a decline in transmitted HIV-1 drug resistance in the United Kingdom
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DOI：
10.1097/qad.0b013e3280b07761
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发表时间：
2007-05-11
期刊：
影响因子：
3.8
通讯作者：
Pillay, Deenan
中科院分区：
文献类型：
--
作者：
Burns, Sheila;Cameron, Sheila;Pillay, Deenan
目的：要检查最近的趋势，在英国的传播耐药（TDR）。方法：分析结果的基因型耐药测试报告的英国艾滋病病毒耐药数据库，其中包括几乎所有的测试进行常规临床护理的一部分，全国。耐药性是基于2005年国际艾滋病协会-美国指南中定义的主要突变。分析仅限于在采样时未接受过抗逆转录病毒治疗的人，如果患者在英国HIV血清转化者登记处共同登记，并且在HIV抗体检测阴性的18个月内采集样本，则该检测定义为与近期感染有关。共分析了1996年至2004年期间4454例初治患者的样本，其中316例来自耐药试验时最近感染的患者。在最初的上升之后，TDR从2001-2002年约14%的峰值下降到2004年底的约8%（P趋势< 0.001），主要是由于核苷逆转录酶抑制剂（NRTI）突变的减少。相对而言，非NRTI耐药变得越来越重要，现在与NRTI耐药一样普遍。在近期感染的患者中，观察到几乎相同的模式，但在约2年前发生了变化。病毒亚型分布的变化并没有解释这些时间trends.Conclusions：这是第一个明确的证据表明，在国家一级的TDR下降。将病毒浓度抑制到感染水平以下的治疗方案的广泛使用是对这一发现的几个合理解释之一。(C)2007年利平科特威廉姆斯&威尔金斯。
Objective: To examine recent trends in transmitted drug resistance (TDR) in the United Kingdom.Methods: Analysis of results of genotypic resistance tests reported to the UK HIV Drug Resistance Database, which includes virtually all tests conducted as part of routine clinical care nationally. Resistance was based on major mutations as defined in the 2005 International AIDS Society-USA guidelines. Analysis was restricted to persons who were antiretroviral treatment-naive at the time of sampling, and a test defined as relating to recent infection if the patient was co-enrolled in the UK Register of HIV Seroconverters and the sample taken within 18 months of a negative HIV antibody test.Results: A total of 4454 samples from treatment-naive patients between 1996 and 2004 were analysed, including 316 from patients recently infected at the time of the resistance test. After an initial rise, TDR declined from a peak of around 14% in 2001-2002 to around 8% by the end of 2004 (P-trend < 0.001), largely driven by a decrease in nucleos(t)ide reverse transcriptase inhibitor (NRTI) mutations. Non-NRTI resistance has become increasingly important in relative terms and is now as common as NRTI resistance. Among patients with recent infection, an almost identical pattern was observed but shifted approximately 2 years earlier. A change in the distribution of viral subtypes did not explain these temporal trends.Conclusions: This is the first clear evidence of a decrease in TDR at national level. The wider use of regimens that suppress viral concentration to below infectious levels is one of several plausible explanations for this finding. (C) 2007 Lippincott Williams & Wilkins.