Time trends in primary HIV-1 drug resistance among recently infected persons
Time trends in primary HIV-1 drug resistance among recently infected persons
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DOI：
10.1001/jama.288.2.181
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发表时间：
2002-07-10
影响因子：
120.7
通讯作者：
Kahn, JO
中科院分区：
文献类型：
--
作者：
Grant, RM;Hecht, FM;Kahn, JO
背景随着抗逆转录病毒治疗的广泛应用，耐多药人类免疫缺陷病毒1型（HIV-1）的传播可能会增加。目的确定在抗病毒治疗高度渗透的地理区域内，最近感染的个体中HIV-1耐药的流行趋势。结果与非核苷类逆转录酶抑制剂（nonnucleotide reverse transcriptase inhibitor，NNRTIs）耐药相关的突变从1996-1997年的0%稳步上升到12 20002001年为13.2%（P=.01）。1996 - 1997年有1例突变与蛋白酶抑制剂耐药相关（2.5%），2000-2001年有7例突变与蛋白酶抑制剂耐药相关（7.7%）（P=.25）。对核苷逆转录酶抑制剂（NRTI）的基因型耐药性最初下降，然后恢复到之前的水平（同质性检验P=.007）。对2种或2种以上药物的基因型耐药从1种（2.5%）增加到12种（13.2%）（P= 0.004），但在后一时期，只有1种感染（1.2%）对所有3种药物均耐药（P= 0.58）。NRTI的主要表型耐药率从21%下降到6.2%（P= 0.03），NNRTI的主要表型耐药率从0增加到8（9.9%）（P= 0.02）。蛋白酶抑制剂的表型耐药率从2.6%增加到6.2%（P=32）。至病毒学抑制的中位时间（
Context Transmission of multiclass drug-resistant human immunodeficiency virus type 1 (HIV-1) may increase with wider use of antiretroviral therapy.Objective To determine trends in prevalence of HIV-1 drug resistance among recently infected individuals in a geographic area with a high penetration of antiviral treatment.Design, Setting, and Patients Consecutive case series of 225 patients referred to a San Francisco, Calif, hospital with recent HIV-1 infection from June 1996 through June 2001.Main Outcome Measure Time trends in the prevalence of genotypic and phenotypic primary drug resistance.Results Mutations associated with resistance to nonnucleoside reverse transcriptase inhibitors (NNRTIs) steadily increased from 0% in 1996-1997 to 12 (13.2%) in 20002001 (P=.01). There was 1 mutation associated with protease inhibitor resistance in 19961997 (2.5%) and there were 7 (7.7%) in 2000-2001 (P=.25). Genotypic resistance to nucleoside reverse transcriptase inhibitors (NRTIs) initially decreased and then returned to prior levels (P=.007 for test of homogeneity). Genotypic resistance to 2 or more classes of drugs increased from 1 (2.5%) to 12 (13.2%) (P=.004), but only 1 infection (1.2%) in the latter period was resistant to all 3 classes of agents (P=.58). Primary phenotypic resistance decreased for NRTIs from 21% to 6.2% (P=.03) and increased for NNRTIs from 0 to 8 (9.9%) (P=.02). Phenotypic resistance increased for protease inhibitors from 2.6% to 6.2% (P=32). Median time to virologic suppression (