Kolupajeva Tatjana, Aldins Pauls, Guseva Ludmila, Dusacka Diana, Sondore Valentina, Viksna Ludmila, Rozentale Baiba
State Agency Infectology Center of Latvia, Riga, Latvia.
Cent Eur J Public Health. 2008 Sep;16(3):138-40. doi: 10.21101/cejph.a3473.
The treatment of HIV infection in Latvia by using highly active antiretroviral therapy (HAART) was started in 1996. The prevalence and tendencies of HIV drug resistance among treated and treatment-naive patients in Latvia in the years 2006-2007 were evaluated in this study. Data of HIV genotyping, performed in 132 HIV-1 infected during years 2006-2007 by TRUGENE HIV-1 genotyping assay (BayerHealthCare-diagnostics) are included in the study. Analysis of data showed that in the group of treatment-naive individuals majority carried wild type virus. Prevalence of resistance-associated mutations (RAMs) in the treatment-naive group according to IAS list was 28%. In most cases it was NRTI mutation A62V that is associated with multinucleoside resistance caused by Q151M, its effect in the absence of Q151M is not known. By many authors A62V is supposed to be a result of polymorphism in RT gene and is excluded from the list of resistance mutations. High prevalence of A62V is typical for HIV-1 subtype A. As majority of treatment-naive cases (89%) in this study were with HIV-1 subtypes A or AE, we excluded A62V mutation and estimated RAMs prevalence in group of treatment-naive HIV-infected individuals as 7%. Minor PI mutations were not included in analyses. In Europe published rates generally very between 5% and 15%. In the group of treatment-experienced HIV infected people 25/75 were with HIV-1 subtype B, the rest part--with non-B subtypes: A/AE (35/75), CRF-01AE (7/75), B/AE (4/75) and others. In treatment-experienced patients RAMs prevalence was estimated as 58.6%. Most frequently RAMs were found for nucleoside reverse transcriptase inhibitors (NRTI) (49.3%) followed by non-nucleoside reverse transcriptase inhibitors (NNRTI) (22.6%) and protease inhibitors (PI) (16%). In the group of NRTI mutations M184V (26/75; 34.6%), A62V (12/75; 16.0%) and T215Y (8/75; 10.6%), in NNRTI mutations K103N (10/75; 13.3%), G190S (6/75; 8.0%), in PI group mutations L90M (6/75; 8.0%) and M461/L (6/75; 8.0%) occurred most frequently. The following drug susceptibility was predicted according to the Trugen expert interpretations: in 33/75 (44%) patients no evidence of resistance, in 21/75 (28%) patients resistance to 1 drug class (NRTI--16/75, NNRTI--4/75, PI--1/75), in 17 patients (22.6%) resistance to 2 drug classes (NRTI+NNRTI--9/75, NRTI+PI--7/75, NNRTI+PI--1/75) and in 3/75 (4%) patients resistance to all 3 classes of drugs (NRTI+NNRTI+PI). We conclude, that prevalence of RAMs in treatment-naive HIV infected persons in Latvia is comparable with prevalence in Europe. The origin of predominated mutation A62V associated with NRTI at present is not clear. In more than half of treated HIV infected patients HIV resistance to at least one HAART class was predicted.
拉脱维亚于1996年开始采用高效抗逆转录病毒疗法（HAART）治疗HIV感染。本研究评估了2006 - 2007年拉脱维亚接受治疗和未接受治疗的患者中HIV耐药性的流行情况及趋势。研究纳入了2006 - 2007年期间通过TRUGENE HIV - 1基因分型检测法（拜耳医疗保健诊断公司）对132例HIV - 1感染者进行HIV基因分型的数据。数据分析表明，在未接受治疗的个体组中，大多数携带野生型病毒。根据国际艾滋病协会（IAS）列表，未接受治疗组中耐药相关突变（RAMs）的流行率为28%。在大多数情况下，是与由Q151M引起的多核苷耐药相关的NRTI突变A62V，其在不存在Q151M时的作用尚不清楚。许多作者认为A62V是RT基因多态性的结果，被排除在耐药突变列表之外。A62V的高流行率是HIV - 1 A亚型的典型特征。由于本研究中大多数未接受治疗的病例（89%）为HIV - 1 A或AE亚型，我们排除了A62V突变，并估计未接受治疗的HIV感染者组中RAMs的流行率为7%。分析未包括轻微的蛋白酶抑制剂（PI）突变。在欧洲公布的比率一般在5%至15%之间。在接受过治疗的HIV感染者组中，75例中有25例为HIV - 1 B亚型，其余为非B亚型：A/AE（75例中的35例）、CRF - 01AE（75例中的7例）、B/AE（75例中的4例）及其他。在接受过治疗的患者中，RAMs的流行率估计为58.6%。最常见的RAMs是针对核苷类逆转录酶抑制剂（NRTI）（49.3%），其次是非核苷类逆转录酶抑制剂（NNRTI）（22.6%）和蛋白酶抑制剂（PI）（16%）。在NRTI突变组中，M184V（26/75；34.6%）、A62V（12/75；16.0%）和T215Y（8/75；10.6%），在NNRTI突变组中，K103N（10/
