Recsky Magdalena A, Brumme Zabrina L, Chan Keith J, Wynhoven Brian, Yip Benita, Dong Winnie W Y, Heath Katherine V, Montaner Julio S G, Levy Adrian R, Hogg Robert S, Harrigan P Richard
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
J Infect Dis. 2004 Jul 15;190(2):285-92. doi: 10.1086/422007. Epub 2004 Jun 11.
The prevalence of antiretroviral resistance among persons enrolled in the centralized HIV/AIDS Drug Treatment Program in British Columbia, Canada, who had died between July 1997 and December 2001, was investigated, to determine the degree to which antiretroviral resistance contributed to mortality.
During this period, 637 deaths had occurred. The last plasma sample obtained during therapy was genotyped retrospectively for treated individuals who had died of a nonaccidental cause. Samples with plasma human immunodeficiency virus (HIV) loads <500 copies/mL were not genotyped. Drug resistance among 1220 living HIV-infected persons who had experienced virologic therapy failure during the study period also was examined.
Of 554 individuals who had died of nonaccidental causes, 58 (10.4%) were antiretroviral naive, and 99 (17.9%) had very brief exposure to antiretroviral therapy (median, 2 months). The majority of isolates from the remaining 397 individuals harbored either no major resistance mutations or represented samples with plasma HIV suppression of <500 copies/mL. Resistance to >/=1, >/=2, or 3 drug classes was observed in 76%, 42%, and 11% of individuals, respectively, in the group of 1220 living individuals experiencing virologic therapy failure, compared with only 44%, 23%, and 5% of individuals, respectively, who had died (P<.001).
Only a relatively low prevalence of multidrug resistance was observed in this cohort, indicating that the exhaustion of treatment options because of drug resistance was not a significant contributor to mortality.
对1997年7月至2001年12月期间在加拿大不列颠哥伦比亚省参加集中式HIV/AIDS药物治疗项目且已死亡者的抗逆转录病毒耐药性流行情况进行了调查，以确定抗逆转录病毒耐药性对死亡率的影响程度。
在此期间，共发生637例死亡。对因非意外原因死亡的接受治疗个体，回顾性分析其治疗期间获得的最后一份血浆样本的基因型。血浆人类免疫缺陷病毒（HIV）载量<500拷贝/mL的样本未进行基因分型。还检查了1220名在研究期间经历病毒学治疗失败的存活HIV感染者的耐药情况。
在554例因非意外原因死亡的个体中，58例（10.4%）未接受过抗逆转录病毒治疗，99例（17.9%）接受抗逆转录病毒治疗的时间非常短（中位数为2个月）。其余397例个体的大多数分离株要么没有主要耐药突变，要么代表血浆HIV抑制水平<500拷贝/mL的样本。在1220例经历病毒学治疗失败的存活个体组中，分别有76%、42%和11%的个体对≥1、≥2或3类药物耐药，而在死亡个体中这一比例分别仅为44%、23%和5%（P<0.001）。
在该队列中仅观察到相对较低的多药耐药率，这表明因耐药导致治疗选择耗尽并非死亡率的重要影响因素。
