2005 - 2009年南卡罗来纳州新诊断HIV感染者中传播的抗逆转录病毒药物耐药性

Transmitted antiretroviral drug resistance in individuals with newly diagnosed HIV infection: South Carolina 2005-2009.

作者信息

Youmans Eren, Tripathi Avnish, Albrecht Helmut, Gibson James J, Duffus Wayne A

机构信息

Arnold School of Public Health, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA.

出版信息

South Med J. 2011 Feb;104(2):95-101. doi: 10.1097/SMJ.0b013e3181fcd75b.

DOI:10.1097/SMJ.0b013e3181fcd75b

PMID:21206421

Abstract

OBJECTIVES

The transmission of drug-resistant human immunodeficiency virus 1 (HIV-1) has important implications for the antiretroviral management of newly diagnosed individuals, increasing the risk of suboptimal treatment outcomes. The study objective was to characterize rates and factors associated with transmitted drug-resistant HIV-1 infection among newly diagnosed South Carolina (SC) residents.

METHODS

This study utilized surveillance genotypic data from antiretroviral therapy (ART)-naïve individuals newly diagnosed with HIV-1 infection from June 2005 through December 2009. Multivariable negative binomial regression was used to model the association between the presence of major mutations and sociodemographic characteristics.

RESULTS

Of the 1,277 study participants, 14.4% (184/1,277) had HIV-1 variants with major antiretroviral drug mutations. Of these individuals, 126 had non-nucleoside reverse transcriptase inhibitor-associated mutations (NNRTI), 54 had nucleos(t)ide reverse transcriptase inhibitor-associated mutations (NRTI), 37 had protease inhibitor-associated mutations (PI). Nineteen (10.3%) individuals had dual class-associated mutations (NNRTI and PI in seven, NNRTI and NRTI in seven, and NRTI and PI in five individuals), and seven (3.8%) individuals had triple drug class-associated mutations (PI, NNRTI, and NRTI). The multivariable negative binomial regression models indicated that age at HIV diagnosis had a significant negative association with total number of mutations (rate ratio [RR] 0.88, 95% confidence interval [CI] 0.80-0.96, P value=0.005) and total number of reverse transcriptase (RT) mutations (RR 0.88, 95% CI 0.80-0.97, P value=0.006) present.

CONCLUSION

Prevalence of transmitted drug resistance is consistently high among newly diagnosed HIV-infected individuals in SC. It is important to continue genotypic surveillance to facilitate effective HIV treatment and empiric post-exposure prophylaxis regimens.

摘要

目的

耐药性人类免疫缺陷病毒1型（HIV-1）的传播对新诊断个体的抗逆转录病毒治疗管理具有重要意义，会增加治疗效果欠佳的风险。本研究的目的是描述南卡罗来纳州（SC）新诊断居民中传播性耐药HIV-1感染的发生率及相关因素。

方法

本研究利用了2005年6月至2009年12月新诊断为HIV-1感染且未接受过抗逆转录病毒治疗（ART）的个体的监测基因分型数据。采用多变量负二项回归模型来分析主要突变的存在与社会人口学特征之间的关联。

结果

在1277名研究参与者中，14.4%（184/1277）的HIV-1变体存在主要抗逆转录病毒药物突变。其中，126人有非核苷类逆转录酶抑制剂相关突变（NNRTI），54人有核苷（酸）类逆转录酶抑制剂相关突变（NRTI），37人有蛋白酶抑制剂相关突变（PI）。19人（10.3%）有双重类别相关突变（7人同时有NNRTI和PI突变，7人同时有NNRTI和NRTI突变，5人同时有NRTI和PI突变），7人（3.8%）有三重药物类别相关突变（PI、NNRTI和NRTI）。多变量负二项回归模型表明，HIV诊断时的年龄与突变总数（发生率比[RR]0.88，95%置信区间[CI]0.80 - 0.96，P值 = 0.005）以及存在的逆转录酶（RT）突变总数（RR 0.88，95% CI 0.80 - 0.97，P值 = 0.006）呈显著负相关。