Palma A C, Araújo F, Duque V, Borges F, Paixão M T, Camacho R
Laboratório de Virologia, Serviço de Imunohemoterapia, Hospital Egas Moniz, Lisboa, Portugal.
Infect Genet Evol. 2007 Jun;7(3):391-8. doi: 10.1016/j.meegid.2007.01.009. Epub 2007 Feb 8.
Drug resistance transmission in newly diagnosed, drug-naïve HIV-1 infected individuals has been previously reported, with rates ranging from 5 to 27%. The aim of this study is to investigate the prevalence of resistance-associated mutations in drug-naïve, newly diagnosed patients, as well as monitoring the diversity of HIV-1 strains circulating in Portugal.
One hundred eighty samples from newly diagnosed patients were prospectively collected during 2003, according to the distribution of HIV-1 infections in Portugal. Epidemiological, clinical and laboratory data was collected using a standardized form. Population sequencing was performed using an automated sequencer (ABI Prism 3100, Applied Biosystems) and a commercially available assay (ViroSeq HIV-1 Genotyping System, v2.0, Abbott). Stanford HIV Sequence Database was used for interpretation of resistance data; subtyping was performed using the REGA Subtyping Tool. When subtype was unassigned, further analysis was done using an alignment with reference sequences, and phylogenetic tools like Simplot and PHYLIP. Mutations listed by the International AIDS Society-USA were considered, except E44D and V118I.
Patient population included 124 males (69%) and 56 females (31%), the median age being 35. Western Europe was the main region of origin (77.2%), followed by Africa (18.3%), South America (2.8%) and Asia (1.1%). The most common route of transmission was heterosexual contact (54.4%), followed by intravenous drug use (20%), homo/bisexual individuals (19.4%) and blood transfusion (0.6%). The commonest subtypes were B (41.7%) and G (29.4%), while other non-B subtypes rated 12.8% and recombinant forms represented 16.1% of the samples. Fourteen patients (7.78%) were identified as carrying resistance-associated mutations. Ten were resistant to drugs from one class, three to drugs from two classes and one to drugs from all three classes. No statistically significant associations were found between age, gender, route of transmission, subtype and resistance.
The identification of newly diagnosed individuals carrying resistance-associated mutations confirms that drug resistance transmission is a public health problem in Portugal, with a possible impact on prevention, treatment and monitoring of HIV-1 infections.
先前已有报道称，在新诊断的、未接受过抗逆转录病毒治疗的HIV-1感染者中存在耐药性传播，发生率在5%至27%之间。本研究旨在调查未接受过抗逆转录病毒治疗的新诊断患者中耐药相关突变的流行情况，并监测葡萄牙境内循环的HIV-1毒株的多样性。
根据葡萄牙HIV-1感染的分布情况，于2003年前瞻性收集了180例新诊断患者的样本。使用标准化表格收集流行病学、临床和实验室数据。采用自动测序仪（ABI Prism 3100，Applied Biosystems）和市售检测方法（ViroSeq HIV-1基因分型系统，v2.0，Abbott）进行群体测序。利用斯坦福HIV序列数据库解释耐药数据；使用REGA亚型分型工具进行亚型分型。当未确定亚型时，使用与参考序列的比对以及Simplot和PHYLIP等系统发育工具进行进一步分析。除E44D和V118I外，考虑美国国际艾滋病协会列出的突变。
患者群体包括124名男性（69%）和56名女性（31%），中位年龄为35岁。西欧是主要来源地区（77.2%），其次是非洲（18.3%）、南美洲（2.8%）和亚洲（1.1%）。最常见的传播途径是异性接触（54.4%），其次是静脉吸毒（20%）、同性恋/双性恋个体（19.4%）和输血（0.6%）。最常见的亚型是B（41.7%）和G（29.4%），而其他非B亚型占12.8%，重组形式占样本的16.1%。14名患者（7.78%）被确定携带耐药相关突变。10名患者对一类药物耐药，3名对两类药物耐药，1名对所有三类药物耐药。在年龄、性别、传播途径、亚型和耐药性之间未发现统计学上的显著关联。
新诊断出携带耐药相关突变的个体证实了耐药性传播在葡萄牙是一个公共卫生问题，可能对HIV-1感染的预防、治疗和监测产生影响。
