Department of Microbiology, National Autonomous University of Honduras, Tegucigalpa, Honduras.
HIV Med. 2010 Feb;11(2):95-103. doi: 10.1111/j.1468-1293.2009.00747.x. Epub 2009 Aug 3.
The Honduran HIV/AIDS Program began to scale up access to HIV therapy in 2002. Up to May 2008, more than 6000 patients received combination antiretroviral therapy (cART). As HIV drug resistance is the major obstacle for effective treatment, the purpose of this study was to assess the prevalence of antiretroviral drug resistance in Honduran HIV-1-infected individuals.
We collected samples from 138 individuals (97 adults and 41 children) on cART with virological, immunological or clinical signs of treatment failure. HIV-1 pol sequences were obtained using an in-house method. Resistance mutations were identified according to the 2007 International AIDS Society (IAS)-USA list and predicted susceptibility to cART was scored using the ANRS algorithm.
Resistance mutations were detected in 112 patients (81%), 74% in adults and 98% in children. Triple-, dual- and single-class drug resistance was documented in 27%, 43% and 11% of the study subjects, respectively. Multiple logistic regression showed that resistance was independently associated with type of treatment failure [virological failure (odds ratio (OR) = 1) vs. immunological failure (OR = 0.11; 95% confidence interval (CI) 0.030-0.43) vs. clinical failure (OR = 0.037; 95% CI 0.0063-0.22)], route of transmission (OR = 42.8; 95% CI 3.73-491), and years on therapy (OR = 1.81; 95% CI 1.11-2.93).
The prevalence of antiretroviral resistance was high in Honduran HIV-infected patients with signs of treatment failure. A majority of study subjects showed dual- or triple-class resistance to nucleoside reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors and protease inhibitors. Virologically defined treatment failure was a strong predictor of resistance, indicating that viral load testing is needed to correctly identify patients with treatment failure attributable to resistance.
洪都拉斯的艾滋病毒/艾滋病规划于 2002 年开始扩大艾滋病毒治疗机会。截至 2008 年 5 月，已有 6000 多名患者接受了联合抗逆转录病毒治疗（cART）。由于艾滋病毒耐药性是有效治疗的主要障碍，本研究的目的是评估洪都拉斯感染艾滋病毒-1 的个体中抗逆转录病毒药物耐药性的流行情况。
我们从 138 名正在接受 cART 治疗且病毒学、免疫学或临床治疗失败迹象的患者中采集了样本。使用内部方法获得 HIV-1 pol 序列。根据 2007 年国际艾滋病协会（IAS）-美国名单确定耐药突变，并使用 ANRS 算法对 cART 的药敏性进行评分。
在 112 名患者（81%）中检测到耐药突变，成人患者中耐药率为 74%，儿童患者中耐药率为 98%。研究对象中分别有 27%、43%和 11%存在三重、双重和单类药物耐药。多因素逻辑回归显示，耐药与治疗失败类型独立相关[病毒学失败（比值比（OR）=1）与免疫学失败（OR=0.11；95%置信区间（CI）0.030-0.43）与临床失败（OR=0.037；95%CI 0.0063-0.22）]、传播途径（OR=42.8；95%CI 3.73-491）和治疗年限（OR=1.81；95%CI 1.11-2.93）。
在出现治疗失败迹象的洪都拉斯感染艾滋病毒的患者中，抗逆转录病毒耐药性的流行率很高。大多数研究对象对核苷逆转录酶抑制剂、非核苷逆转录酶抑制剂和蛋白酶抑制剂表现出双重或三重耐药。病毒学定义的治疗失败是耐药的一个强有力的预测因素，这表明需要进行病毒载量检测，以正确识别因耐药而导致治疗失败的患者。
