Istituto di Clinica delle Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.
Curr Opin HIV AIDS. 2010 Jan;5(1):27-37. doi: 10.1097/COH.0b013e328333ad45.
Access to antiretroviral therapy (ART) has been scaled-up in low-middle income countries (LMICs), where the majority of the world's HIV-1-infected population is living. Concerns towards the emergence and spread of HIV-1 drug resistance exist, given the lack of virological monitoring which may give rise to accumulation of resistance as well as the use of suboptimal ART in pregnant women with the aim to reduce perinatal transmission. Knowledge of the prevalence of transmitted and emerging drug resistance as well as its specific patterns is of help in guiding the selection of appropriate ART types and sequencing strategies.
Whereas transmitted drug resistance in LMIC is still limited, resistance in pregnant women as a consequence of suboptimal ART for the prevention of vertical transmission is frequent and dependent on viral subtype and load. Accumulation of drug resistance during first-line ART depends on the frequency of monitoring, whereas mutational patterns are influenced by type of ART and, partly, viral subtype.
Optimized ART for prevention of mother-to-child transmission and closer monitoring of ART programs with the inclusion of viral load may help reducing unnecessary development of HIV drug resistance in LMIC and preserve the limited available treatment options.
目的综述：抗逆转录病毒疗法（ART）在中低收入国家（LMIC）得到了广泛应用，而世界上大多数 HIV-1 感染者都生活在这些国家。由于缺乏病毒学监测，可能会导致耐药性的积累，以及为降低母婴传播而在孕妇中使用不太理想的 ART，人们对 HIV-1 耐药性的出现和传播存在担忧。了解传播和新出现的耐药性及其具体模式有助于指导选择合适的 ART 类型和测序策略。
最近发现：虽然 LMIC 中的传播性耐药性仍然有限，但由于预防垂直传播的 ART 不太理想，孕妇中的耐药性很常见，这取决于病毒亚型和载量。一线 ART 期间耐药性的积累取决于监测的频率，而突变模式受 ART 的类型和部分病毒亚型的影响。
总结：优化用于预防母婴传播的 ART 和更密切地监测 ART 项目，包括病毒载量，可能有助于减少在 LMIC 中不必要的 HIV 耐药性的发展，并保留有限的可用治疗选择。
