Nevin Christa R, Ye Jiatao, Aban Inmaculada, Mugavero Michael J, Jackson David, Lin Hui-Yi, Allison Jeroan, Raper James L, Saag Michael S, Willig James H
Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, USA.
AIDS Res Hum Retroviruses. 2011 Sep;27(9):957-63. doi: 10.1089/AID.2010.0291. Epub 2011 Mar 21.
In an effort to evaluate factors associated with the development of antiretroviral (ARV) resistance, we assessed the prevalence of toxicity-related regimen changes and modeled its association to the subsequent development of ARV resistance in a cohort of treatment-naive individuals initiating ARV therapy (ART). A retrospective analysis of patients initiating ART was conducted at the UAB 1917 Clinic from 1 January 2000 to 30 September 2007. Cox proportional hazards models were fit to identify factors associated with the development of resistance to ≥1 ARV drug class. Among 462 eligible participants, 14% (n=64) developed ARV resistance. Individuals with ≥1 toxicity-related regimen change (HR=3.94, 95% CI=1.09-14.21), initiating ART containing ddI or d4T (4.12, 1.19-14.26), and from a minority race (2.91, 1.16-7.28) had increased risk of developing resistance. Achieving virologic suppression within 12 months of ART initiation (0.10, 0.05-0.20) and higher pretreatment CD4 count (0.85 per 50 cells/mm(3), 0.75-0.96) were associated with decreased hazards of resistance. Changes in ART due to drug intolerance were associated with the subsequent development of ARV resistance. Understanding the role of ARV drug selection and other factors associated with the emergence of ARV resistance will help inform interventions to improve patient care and ensure long-term treatment success.
为了评估与抗逆转录病毒（ARV）耐药性发展相关的因素，我们在一组开始接受抗逆转录病毒治疗（ART）的初治个体中，评估了与毒性相关的治疗方案改变的发生率，并对其与随后ARV耐药性发展的关联进行了建模。2000年1月1日至2007年9月30日，在UAB 1917诊所对开始接受ART治疗的患者进行了回顾性分析。采用Cox比例风险模型来确定与对≥1类ARV药物产生耐药性相关的因素。在462名符合条件的参与者中，14%（n = 64）出现了ARV耐药性。有≥1次与毒性相关的治疗方案改变的个体（风险比[HR]=3.94，95%置信区间[CI]=1.09 - 14.21）、开始接受含去羟肌苷（ddI）或司他夫定（d4T）的ART治疗的个体（4.12，1.19 - 14.26）以及少数族裔个体（2.91，1.16 - 7.28）发生耐药性的风险增加。在ART开始后12个月内实现病毒学抑制（0.10，0.05 - 0.20）和较高的治疗前CD4细胞计数（每50个细胞/mm³为0.85，0.75 - 0.96）与耐药性风险降低相关。因药物不耐受导致的ART方案改变与随后ARV耐药性的发展有关。了解ARV药物选择的作用以及与ARV耐药性出现相关的其他因素，将有助于为改善患者护理和确保长期治疗成功的干预措施提供依据。
