Moderate Levels of Pre-Treatment HIV-1 Antiretroviral Drug Resistance Detected in the First South African National Survey
Moderate Levels of Pre-Treatment HIV-1 Antiretroviral Drug Resistance Detected in the First South African National Survey
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DOI：
10.1371/journal.pone.0166305
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发表时间：
2016-12-01
期刊：
影响因子：
3.7
通讯作者：
Stevens, Wendy S.
中科院分区：
文献类型：
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作者：
Steegen, Kim;Carmona, Sergio;Stevens, Wendy S.
背景为了评估传播和/或治疗前抗逆转录病毒药物对HIV-1的耐药性水平，世界卫生组织（WHO）建议进行定期调查。本研究的目的是评估频率的HIV-1抗逆转录病毒药物耐药性的患者开始抗逆转录病毒治疗（ART）在公共部门在整个SouthAfrica.MethodsA前瞻性横断面调查进行概率比例大小抽样。这一方法确保根据每个地区接受抗逆转录病毒疗法的患者人数按比例从每个省收集样本。样本采集时间为2013年3月至2014年10月。采用RTPCR和桑格测序获得Po/1序列，并提交给斯坦福大学校准群体抗性工具v6.0。大多数参与者为女性（58.8%），中位年龄为34岁（IQR：29-42）。中位基线CD 4计数为149个细胞/mm 3（IQR：62-249），根据自我报告，参与者在样本采集前约44天被诊断为HIV阳性（IQR：23-179）。分型结果显示98.2%为HIV-1C亚型感染。总体而言，277例患者中有25例出现≥ 1个监测耐药突变（SDRM，9.0%，95% CI：6.1-13.0%）。非核苷逆转录酶抑制剂（NNRTI）突变是检测到的最多的突变（n = 23）。只有两名患者出现蛋白酶抑制剂（PI）突变。在4例患者>= 4 SDRMs被检测到，这可能表明，这些患者不是真正的ART-天真的或感染了多重耐药virus.ConclusionsThese结果表明，抗逆转录病毒药物耐药性的ART-天真的南非人的水平已达到中等水平，按照世界卫生组织的分类。因此，强烈建议在南非所有地区定期调查治疗前药物耐药性水平，以监测治疗前抗逆转录病毒药物耐药性水平的变化。
BackgroundIn order to assess the level of transmitted and/or pre-treatment antiretroviral drug resistance to HIV-1, the World Health Organization (WHO) recommends that regular surveys are conducted. This study's objective was to assess the frequency of HIV-1 antiretroviral drug resistance in patients initiating antiretroviral treatment (ART) in the public sector throughout South Africa.MethodsA prospective cross-sectional survey was conducted using probability proportional to size sampling. This method ensured that samples from each province were proportionally collected, based on the number of patients receiving ART in each region. Samples were collected between March 2013 and October 2014. Po/sequences were obtained using RTPCR and Sanger sequencing and submitted to the Stanford Calibrated Population Resistance tool v6.0.ResultsA total of 277 sequences were available for analysis. Most participants were female (58.8%) and the median age was 34 years (IQR: 29-42). The median baseline CD4-count was 149 cells/mm3 (IQR: 62-249) and, based on self-reporting, participants had been diagnosed as HIV-positive approximately 44 days prior to sample collection (IQR: 23-179). Subtyping revealed that 98.2% were infected with HIV-1 subtype C. Overall, 25 out of 277 patients presented with >= 1 surveillance drug resistance mutation (SDRM, 9.0%, 95% CI: 6.1-13.0%). Non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations were the most numerous mutations detected (n = 23). Only two patients presented with a protease inhibitor (PI) mutation. In four patients >= 4 SDRMs were detected, which might indicate that these patients were not truly ART-naive or were infected with a multi-resistant virus.ConclusionsThese results show that the level of antiretroviral drug resistance in ART-na ve South Africans has reached moderate levels, as per the WHO classification. Therefore, regular surveys of pre-treatment drug resistance levels in all regions of South Africa is highly recommended to monitor the changing levels of pre-treatment antiretroviral drug resistance.