Riva Chiara, Lai Alessia, Caramma Ilaria, Corvasce Stefano, Violin Michela, Dehò Lorenzo, Prati Francesca, Rossi Cristina, Colombo Maria Chiara, Capetti Amedeo, Franzetti Marco, Rossini Valeria, Tambussi Giuseppe, Ciccozzi Massimo, Suligoi Barbara, Mussini Cristina, Rezza Giovanni, Balotta Claudia
Department of Clinical Sciences 'L. Sacco' Hospital, University of Milan, Italy.
AIDS Res Hum Retroviruses. 2010 Jan;26(1):41-9. doi: 10.1089/aid.2009.0057.
The patterns of transmitted drug-resistant (TDR) HIV-1 variants, non-B subtype spread, and epidemiological trends were evaluated either in seroconverters or in newly diagnosed individuals in Italy over a 13-year period. We analyzed 119 seroconverters, enrolled from 1992 to 2003 for the CASCADE study, and 271 newly diagnosed individuals of the SPREAD study (2002-2005), of whom 42 had a known seroconversion date. Overall, TDR was 15.1% in the CASCADE and 12.2% in the SPREAD study. In the 1992-2003 period, men having sex with men (MSMs) and heterosexuals (HEs) were 48.7% and 36.8%, respectively; TDR was found to be higher in MSMs compared to HEs (78.9% vs. 21%, p = 0.006). The same groups were 39.1% and 53.3% in the SPREAD study; however, no association was detected between modality of infection and TDR. Overall, 9.2% and 22.1% of individuals harbored a non-B clade virus in the CASCADE and SPREAD study, respectively. As evidence of onward transmission, 40% (24/60) of non-B variants were carried by European individuals in the latter study; among these patients the F1 subtype was highly prevalent (p = 0.00001). One of every eight patients who received a diagnosis of HIV-1 in recent years harbored a resistant variant, reinforcing the arguments for baseline resistance testing to customize first-line therapy in newly infected individuals. The spread of non-B clades may act as a dilution factor of TDR concealing the proportion of TDR in seroconverters and MSMs.
在13年的时间里，我们对意大利血清转化者或新诊断个体中传播的耐药性（TDR）HIV-1变异模式、非B亚型传播情况及流行病学趋势进行了评估。我们分析了1992年至2003年为开展CASCADE研究而招募的119名血清转化者，以及SPREAD研究（2002 - 2005年）中的271名新诊断个体，其中42人有已知的血清转化日期。总体而言，CASCADE研究中TDR为15.1%，SPREAD研究中为12.2%。在1992 - 2003年期间，男男性行为者（MSM）和异性恋者（HE）分别占48.7%和36.8%；发现MSM中的TDR高于HE（78.9%对21%，p = 0.006）。在SPREAD研究中，这两组分别占39.1%和53.3%；然而，未检测到感染方式与TDR之间存在关联。总体而言，CASCADE研究和SPREAD研究中分别有9.2%和22.1%的个体携带非B亚型病毒。作为进一步传播的证据，在后者的研究中，40%（24/60）的非B亚型变异由欧洲个体携带；在这些患者中，F1亚型高度流行（p = 0.00001）。近年来每8名被诊断为HIV-1的患者中就有1人携带耐药变异，这进一步支持了进行基线耐药检测以针对新感染个体定制一线治疗方案的观点。非B亚型的传播可能作为TDR的稀释因素，掩盖了血清转化者和MSM中TDR的比例。
