Linking HIV and antiretroviral drug resistance surveillance in Peru: A model for a third-generation HIV sentinel surveillance
Linking HIV and antiretroviral drug resistance surveillance in Peru: A model for a third-generation HIV sentinel surveillance
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DOI：
10.1097/01.qai.0000221677.29693.dd
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发表时间：
2006-08-01
影响因子：
3.6
通讯作者：
Grant, Robert M.
中科院分区：
文献类型：
--
作者：
Lama, Javier R.;Sanchez, Jorge;Grant, Robert M.
背景资料：艾滋病毒耐药性监测是有限的招聘和选择偏见和有限的信息，艾滋病毒的发病率，继发性耐药，和treatment patients.Methods：第二代艾滋病毒哨兵监测男性与男性发生性关系（MSM），无论以前的历史，艾滋病毒筛查，血清状态，或治疗，在秘鲁于2002年进行。使用敏感/不太敏感的酶免疫测定检测估计最近的HIV感染。结果：3280名受试者中HIV感染率为13.9%（456例HIV阳性）。HIV发病率估计为5.1/100人-年（95%置信区间：3.1-8.3）。在143名男男性行为者中，只有20人（14.0%）在接受抗逆转录病毒治疗（ARV）。基因分型成功的359例初治患者中有12例（3.3%）和16例有治疗经验的参与者中有5例（31.3%）发现了ARV耐药突变。一名来自利马的最近感染的男子表现出3级多药耐药性。在利马的未接受过治疗的慢性感染者中观察到的最常见突变是M184 V（1.7%），D30 N（1.3%），L90 M（1.3%）和L10 I结论：在秘鲁，未接受过抗逆转录病毒治疗的男男性行为者中抗逆转录病毒药物耐药性的流行率较低，反映了2004年之前获得治疗的机会有限，这与发达国家的抗逆转录病毒治疗史形成对比，在发达国家，在引入高效抗逆转录病毒治疗之前就出现了高水平的核苷逆转录酶抑制剂耐药性。在发展中国家，将抗逆转录病毒药物耐药性与艾滋病毒哨点监测联系起来是可行的，应在第三代艾滋病毒哨点监测方案中予以考虑。
Background: HIV drug resistance surveillance is limited by recruitment and selection bias and by limited information regarding HIV incidence rates, secondary resistance, and treatment prevalence.Methods: A second-generation HIV sentinel surveillance among men who have sex with men (MSM), regardless of prior history of HIV screening, serostatus, or treatment, was conducted in Peru in 2002. Recent HIV infection was estimated using sensitive/less sensitive enzyme immunoassay testing. Genotypic resistance testing was performed.Results: HIV prevalence was 13.9% (456 HIV positive of 3280 participants). HIV incidence was estimated to be 5.1 per 100 person-years (95% confidence interval: 3.1-8.3). Among 143 MSM who were aware of their HIV infection before testing, only 20 (14.0%) were receiving antiretrovirals (ARV). Mutations conferring ARV resistance were found in 12 (3.3%) of 359 treatment-naive and 5 (31.3%) of 16 treatment-experienced participants with successful genotyping. One recently infected man from Lima demonstrated 3-class multidrug resistance. The most frequency observed mutations in treatment-naive, chronically infected persons from Lima were M184V (1.7%), D30N (1.3%), L90M (1.3%), and L10I (1.3%).Conclusions: The prevalence of ARV resistance among treatment-naive MSM in Peru is low, reflecting limited access to treatment before 2004, and contrasts with the history of ARV treatment in developed countries, where high levels of nucleoside reverse transcriptase inhibitor resistance occurred before introduction of highly active antiretroviral therapy. Linking ARV resistance and HIV sentinel surveillance in developing settings is feasible and should be considered in third-generation HIV sentinel surveillance programs.