泰国的HIV-1耐药性：国家抗逆转录病毒治疗项目实施前后

HIV-1 drug resistance in Thailand: before and after National Access to Antiretroviral Program.

作者信息

Sutthent Ruengpung, Arworn Daungnapa, Kaoriangudom Surapol, Chokphaibulkit Kulkanya, Chaisilwatana Pongsakdi, Wirachsilp Piyanot, Thiamchai Vipa, Sirapraphasiri Thaweesarp, Tanprasertsuk Sombat

机构信息

National HIV Repository and Bioinformatic Center (Thailand), Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok 10700, Thailand.

出版信息

J Clin Virol. 2005 Dec;34(4):272-6. doi: 10.1016/j.jcv.2005.02.014. Epub 2005 Apr 15.

DOI:10.1016/j.jcv.2005.02.014

PMID:16286051

Abstract

BACKGROUND

The Ministry of Public Health (Thailand), MoPH, has had a program called National Access to Antiretroviral Program for People who have AIDS (PHA) or "NAPHA", to offer free antiretroviral drugs (ARV), which are locally produced in Thailand, to any HIV-1 infected patients with CD4<200 since 2002. This program may increase usage of ARV therapy and the emergence of HIV-1 drug resistance.

OBJECTIVES

To monitor HIV-1 ARV drug resistant codon mutation in Thailand before and after the "NAPHA" program.

MATERIALS AND METHODS

EDTA blood samples were collected from 542 HIV-1 infected subjects, who received ARV therapy in 1999 and 2001-2003, and perinatal chemoprophylaxis in 1998 and 2000. HIV-1 pol nucleotide sequences were analyzed.

RESULTS

The percentage of drug resistant detection from the ARV therapy group in 1999 and 2001-2003 were 12.14 (34/280), 10.23 (9/88), 86.96 (20/23) and 57.55 (61/106), respectively. Of 332 NRTI drug resistant codon mutation, 226 (68.07%) were thymidine analogue mutations (TAMs). The percentage of TAMs detection in 1999 and 2001-2003 were 7.14 (20/280), 9.09 (8/88), 56.52 (13/23) and 43.34 (46/106), respectively. Of 105 NNRTI drug resistant codon mutation, 95 (90.48%) were related to nevirapine drug resistance.

CONCLUSION

Thailand may need more appropriate monitoring of drug resistance in the free ARV therapy program to protect the future usage of drugs by minimizing the emergence of drug resistance.

摘要

背景

泰国公共卫生部（MoPH）实施了一项名为“国家艾滋病患者抗逆转录病毒治疗项目”（PHA）或“NAPHA”的计划，自2002年起向所有CD4细胞计数低于200的HIV-1感染患者免费提供在泰国本土生产的抗逆转录病毒药物（ARV）。该计划可能会增加ARV疗法的使用以及HIV-1耐药性的出现。

目的

监测“NAPHA”计划实施前后泰国HIV-1 ARV耐药密码子突变情况。

材料与方法

采集了542例HIV-1感染受试者的乙二胺四乙酸（EDTA）血样，这些受试者在1999年、2001 - 2003年接受了ARV治疗，并在1998年和2000年接受了围产期化学预防。对HIV-1 pol核苷酸序列进行了分析。

结果

1999年以及2001 - 2003年ARV治疗组的耐药检测百分比分别为12.14%（34/280）、10.23%（9/88）、86.96%（20/23）和57.55%（61/106）。在332个核苷类逆转录酶抑制剂（NRTI）耐药密码子突变中，226个（68.07%）为胸苷类似物突变（TAMs）。1999年以及2001 - 2003年TAMs的检测百分比分别为7.14%（20/280）、9.09%（8/88）、56.52%（13/23）和43.34%（46/106）。在105个非核苷类逆转录酶抑制剂（NNRTI）耐药密码子突变中，95个（90.48%）与奈韦拉平耐药有关。