Bannister Wendy P, Cozzi-Lepri Alessandro, Clotet Bonaventura, Mocroft Amanda, Kjaer Jesper, Reiss Peter, von Wyl Viktor, Lazzarin Adriano, Katlama Christine, Phillips Andrew N, Ruiz Lidia, Lundgren Jens D
Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, United Kingdom.
J Acquir Immune Defic Syndr. 2008 Jul 1;48(3):324-33. doi: 10.1097/QAI.0b013e31817ae5c0.
To investigate prevalence of transmitted drug-resistant human immunodeficiency virus (TDR) and factors associated with TDR and to compare virological and CD4 count response to combination antiretroviral therapy.
In this study, 525 mostly chronically infected EuroSIDA patients were included who had genotypic resistance tests performed on plasma samples collected while antiretroviral therapy naive. TDR was defined as at least one resistance mutation from a list proposed for genotypic TDR surveillance. Multivariable logistic regression was used to analyze factors associated with detection of TDR, with virological (viral load<500 copies/mL) and CD4 count response (>or=50% increase) to combination antiretroviral therapy at months 6-12.
The overall prevalence of TDR was 11.4%, which was stable over 1996-2004. There were no significant differences in virological suppression (those resistant to at least one drug prescribed versus susceptible), adjusted odds ratio: 0.68 (95% confidence interval: 0.27 to 1.71; P=0.408) or CD4 count response, adjusted odds ratio: 1.65 (95% confidence interval: 0.73 to 3.73; P=0.231).
Prevalence of TDR in antiretroviral-naive patients was found to be in line with other European studies. No significant differences were found in virological and CD4 count response after initiation of first-line combination antiretroviral therapy between resistant and susceptible patients, possibly due to the small number of patients with resistance and consequently low power.
调查传播性耐药人类免疫缺陷病毒（TDR）的流行情况及其相关因素，并比较联合抗逆转录病毒治疗的病毒学和CD4细胞计数反应。
本研究纳入了525例大多为慢性感染的欧洲艾滋病临床数据库（EuroSIDA）患者，这些患者在未接受抗逆转录病毒治疗时采集血浆样本进行基因耐药检测。TDR定义为来自用于基因TDR监测的列表中的至少一种耐药突变。采用多变量逻辑回归分析与TDR检测相关的因素，以及在6至12个月时联合抗逆转录病毒治疗的病毒学（病毒载量<500拷贝/mL）和CD4细胞计数反应（增加≥50%）。
TDR的总体流行率为11.4%，在1996 - 2004年期间保持稳定。在病毒学抑制方面（对至少一种处方药物耐药者与敏感者相比）无显著差异，调整后的优势比为0.68（95%置信区间：0.27至1.71；P = 0.408），在CD4细胞计数反应方面，调整后的优势比为1.65（95%置信区间：0.73至3.73；P = 0.231）。
未接受抗逆转录病毒治疗患者中TDR的流行率与其他欧洲研究一致。在开始一线联合抗逆转录病毒治疗后，耐药患者和敏感患者在病毒学和CD4细胞计数反应方面未发现显著差异，可能是由于耐药患者数量较少，因此检验效能较低。
