AIDS. 2008 Mar 12;22(5):625-35. doi: 10.1097/QAD.0b013e3282f5e062.
The spread of drug-resistant HIV-1 might compromise the future success of current first-line regimens.
To analyse the extent and impact of transmission of drug-resistant HIV-1 variants in Europe.
The European prospective programme (SPREAD) collected demographic, clinical and virological data from 1245 HIV-1-infected individuals in 17 countries diagnosed in 2002-2003. The potential impact of transmitted drug resistance mutations (TDRMs) on therapy response was determined by using genotypic interpretation algorithms.
The overall prevalence of viruses with drug-resistance mutations was 9.1% [96/1050; 95% confidence interval: 7.5-11.1]. The majority (71%) harboured only a single amino acid substitution with limited effect on predicted drug susceptibility. Mutations associated with resistance to nucleoside reverse transcriptase inhibitors were observed most frequently [57/1050 (5.4%)], followed by mutations related to protease inhibitors [32/1050 (3.0%)] and mutations related to non-nucleoside reverse transcriptase inhibitors (NNRTIs) [27/1050 (2.6%)]. In some cases, however, resistance was quite extensive. Four individuals were infected with viruses with reduced susceptibility to all nucleoside reverse transcriptase inhibitors, 3 to all protease inhibitors and 20 to both NNRTIs. Remarkably, in one individual, the resistance pattern was so extensive that none of the available current antiretroviral drugs was predicted to be fully active.
The prevalence of TDRM-HIV is quite prominent (9.1%) but did not increase in comparison with a large retrospective European study. Particularly the presence of single NNRTI mutations may impact the efficacy of the first-line regimens. Continuous prospective monitoring remains indicated to explore the patterns and factors contributing to the transmission of TDRMs as well as the potential clinical consequences.
耐药性HIV-1的传播可能会影响当前一线治疗方案未来的疗效。
分析欧洲耐药性HIV-1变异株传播的程度及影响。
欧洲前瞻性项目（SPREAD）收集了2002年至2003年在17个国家诊断出的1245例HIV-1感染者的人口统计学、临床和病毒学数据。通过使用基因型解释算法确定传播耐药突变（TDRMs）对治疗反应的潜在影响。
携带耐药突变的病毒总体流行率为9.1%[96/1050；95%置信区间：7.5 - 11.1]。大多数（71%）仅携带单个氨基酸替代，对预测的药物敏感性影响有限。与核苷类逆转录酶抑制剂耐药相关的突变最为常见[57/1050（5.4%）]，其次是与蛋白酶抑制剂相关的突变[32/1050（3.0%）]和与非核苷类逆转录酶抑制剂（NNRTIs）相关的突变[27/1050（2.6%）]。然而，在某些情况下，耐药情况相当广泛。4例个体感染的病毒对所有核苷类逆转录酶抑制剂敏感性降低，3例对所有蛋白酶抑制剂敏感性降低，20例对NNRTIs均敏感性降低。值得注意的是，有1例个体的耐药模式非常广泛，预计现有的抗逆转录病毒药物均无完全活性。
TDRM-HIV的流行率相当突出（9.1%），但与一项大型欧洲回顾性研究相比并未增加。特别是单个NNRTI突变的存在可能会影响一线治疗方案的疗效。仍需持续进行前瞻性监测，以探索导致TDRMs传播的模式和因素以及潜在的临床后果。
