High-Levels of Acquired Drug Resistance in Adult Patients Failing First-Line Antiretroviral Therapy in a Rural HIV Treatment Programme in KwaZulu-Natal, South Africa
High-Levels of Acquired Drug Resistance in Adult Patients Failing First-Line Antiretroviral Therapy in a Rural HIV Treatment Programme in KwaZulu-Natal, South Africa
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DOI：
10.1371/journal.pone.0072152
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发表时间：
2013-08-21
期刊：
影响因子：
3.7
通讯作者：
de Oliveira, Tulio
中科院分区：
文献类型：
--
作者：
Manasa, Justen;Lessells, Richard J.;de Oliveira, Tulio
目的：确定南非农村初级卫生保健项目中获得性抗逆转录病毒药物耐药的频率和模式。设计：艾滋病治疗项目中嵌套的横断面研究。方法：成人（>= 18岁）最初接受一线司他夫定或齐多夫定抗逆转录病毒治疗（ART）方案治疗并有病毒学失败证据的HIV感染者（1例病毒载量>1000拷贝/ml）。使用内部SATuRN/Life Technologies系统进行基因型耐药性检测。序列进行了分析和基因型敏感性评分（GSS）的标准二线方案进行了计算，使用斯坦福大学HIVDB 6.0.5 algorithm.Results：2010年12月和2012年3月之间，共有222名成人成功基因型HIV耐药。最常见的治疗方案是司他夫定、拉米夫定和依法韦仑（51%）;司他夫定、拉米夫定和奈韦拉平（24%）。ART的中位持续时间为42个月（四分位距（IQR）32-53），抗逆转录病毒治疗失败的中位持续时间为27个月（IQR 17-40）。191例（86%）患者至少有一种耐药突变。对于34名患者（15%），标准二线治疗方案的GSS为
Objective: To determine the frequency and patterns of acquired antiretroviral drug resistance in a rural primary health care programme in South Africa.Design: Cross-sectional study nested within HIV treatment programme.Methods: Adult (>= 18 years) HIV-infected individuals initially treated with a first-line stavudine- or zidovudine-based antiretroviral therapy (ART) regimen and with evidence of virological failure (one viral load >1000 copies/ml) were enrolled from 17 rural primary health care clinics. Genotypic resistance testing was performed using the in-house SATuRN/Life Technologies system. Sequences were analysed and genotypic susceptibility scores (GSS) for standard second-line regimens were calculated using the Stanford HIVDB 6.0.5 algorithms.Results: A total of 222 adults were successfully genotyped for HIV drug resistance between December 2010 and March 2012. The most common regimens at time of genotype were stavudine, lamivudine and efavirenz (51%); and stavudine, lamivudine and nevirapine (24%). Median duration of ART was 42 months (interquartile range (IQR) 32-53) and median duration of antiretroviral failure was 27 months (IQR 17-40). One hundred and ninety one (86%) had at least one drug resistance mutation. For 34 individuals (15%), the GSS for the standard second-line regimen was