Iarikov Dmitri E, Irizarry-Acosta Melina, Martorell Claudia, Hoffman Robert P, Skiest Daniel J
Division of Infectious Diseases, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA.
J Int Assoc Physicians AIDS Care (Chic). 2010 Jul-Aug;9(4):227-31. doi: 10.1177/1545109710374998.
Most studies of primary antiretroviral (ARV) resistance have been conducted in large metropolitan areas with reported rates of 8% to 25%. We collected data on 99 HIV-1-infected antiretroviral-naive patients from several sites in Springfield, MA, who underwent genotypic resistance assay between 2004 and 2008. Only major resistance mutations per International AIDS Society-USA (IAS-USA) drug resistance mutations list were considered. The prevalence of resistance was 5% (5 of 99). Three patients had one nonnucleoside reverse transcriptase inhibitor (NNRTI) mutation: 103N, 103N, and 190A, 1 patient had a protease inhibitor (PI) mutation: 90M; and 1 patient had 3-class resistance with NNRTI: 181C, 190A, PI: 90M, and nucleoside analogue reverse transcriptase inhibitor (NRTI): 41L, 210W. Mean time from HIV diagnosis to resistance testing was shorter in patients with resistance versus those without: 9 (range 0.3-42 months) versus 27 (range 0.1-418 months), P = .11. There was a trend to lower mean CD4 count in those with resistance, 170 versus 318 cells/mm(3), P = .06. No differences were noted in gender, age, HIV risk category, or HIV RNA level. The low prevalence of primary resistance may be explained by differences in demographic and risk factors or may reflect the time from infection to resistance testing. Our findings emphasize the importance of continued resistance surveillance.
大多数关于原发性抗逆转录病毒（ARV）耐药性的研究是在大城市地区进行的，报告的耐药率为8%至25%。我们收集了来自马萨诸塞州斯普林菲尔德多个地点的99例未接受过抗逆转录病毒治疗的HIV-1感染患者的数据，这些患者在2004年至2008年间接受了基因型耐药性检测。仅考虑美国国际艾滋病协会（IAS-USA）耐药性突变列表中的主要耐药突变。耐药率为5%（99例中的5例）。3例患者有1种非核苷类逆转录酶抑制剂（NNRTI）突变：103N、103N和190A，1例患者有蛋白酶抑制剂（PI）突变：90M；1例患者有3类耐药，包括NNRTI：181C、190A，PI：90M，以及核苷类似物逆转录酶抑制剂（NRTI）：41L、210W。耐药患者从HIV诊断到耐药检测的平均时间比未耐药患者短：分别为9个月（范围0.3 - 42个月）和27个月（范围0.1 - 418个月），P = 0.11。耐药患者的平均CD4细胞计数有降低趋势，分别为170个/mm³和318个/mm³，P = 0.06。在性别、年龄、HIV风险类别或HIV RNA水平方面未发现差异。原发性耐药的低发生率可能是由于人口统计学和风险因素的差异所致，也可能反映了从感染到耐药检测的时间。我们的研究结果强调了持续进行耐药监测的重要性。
