Hamers Raph L, Wensing Annemarie Mj, Back Nicole Kt, Arcilla Maria S, Frissen Jos Ph
Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
Antivir Ther. 2011;16(1):115-8. doi: 10.3851/IMP1683.
We report a 33-year-old HIV type-1 (HIV-1)-infected male from Sierra Leone who harboured extensive drug resistance mutations to all nucleoside reverse transcriptase inhibitors (NRTIs) and non-NRTIs, including the multi-NRTI-resistance Q151M complex, K65R, M184I and Y181I, after using standard first-line generic fixed-dose stavudine, lamivudine and nevirapine (Triomune™) for 36 months. In the context of non-B subtypes in resource-limited countries, first-line stavudine-containing regimens have been associated with more extensive and complex mutation patterns, compared with subtype B viruses. Whether the extensive and complex NRTI resistance patterns found among African patients failing first-line antiretroviral therapy is explained by viral genetic diversity or by different patient monitoring strategies remains to be elucidated. Emerging multi-NRTI resistance in sub-Saharan Africa would not only compromise second-line treatment options and the success of antiretroviral rollout, but could also contribute to the spread of drug-resistant variants worldwide.
我们报告了一名来自塞拉利昂的33岁感染1型人类免疫缺陷病毒（HIV-1）的男性，在使用标准一线通用固定剂量的司他夫定、拉米夫定和奈韦拉平（三协唯™）36个月后，他对所有核苷类逆转录酶抑制剂（NRTIs）和非核苷类逆转录酶抑制剂均携带广泛的耐药突变，包括多NRTI耐药的Q151M复合体、K65R、M184I和Y181I。在资源有限国家的非B亚型背景下，与B亚型病毒相比，含司他夫定的一线治疗方案与更广泛、更复杂的突变模式相关。在接受一线抗逆转录病毒治疗失败的非洲患者中发现的广泛而复杂的NRTI耐药模式，究竟是由病毒基因多样性还是不同的患者监测策略所导致，仍有待阐明。撒哈拉以南非洲地区新出现的多NRTI耐药不仅会影响二线治疗方案的选择和抗逆转录病毒治疗推广的成效，还可能促使耐药变异株在全球范围内传播。
