在印度班加罗尔，与一线高效抗逆转录病毒治疗（HAART）相关的病毒学失败和耐药突变有关的不依从性。
Suboptimal adherence associated with virological failure and resistance mutations to first-line highly active antiretroviral therapy (HAART) in Bangalore, India.
机构信息
University of California-San Francisco, Department of Medicine, 50 Beale Street, S-1300, San Francisco, CA 94105, USA.
出版信息
Int Health. 2011 Mar;3(1):27-34. doi: 10.1016/j.inhe.2010.11.003.
This study was conducted to examine the relationship between adherence, viral load (VL) and resistance among outpatients receiving highly active antiretroviral therapy (HAART) in Bangalore, India. In total, 552 outpatients were recruited and VL testing was conducted for all study participants. HIV-1 genotypic resistance testing was performed for 92 participants with a VL ≥ 1000 copies/ml. Interpretation of resistance mutations was performed according to the Stanford database. Past-month adherence and treatment interruptions for >48 h were assessed via self-report. At baseline, 34 participants (6%) reported <95% past-month adherence and 110 (20%) reported a history of >48 h treatment interruptions. Combining the two adherence measures, 22% of participants were classified as 'suboptimally adherent'. In total, 24% of study participants (n = 132) had a detectable VL. Among the 92 samples sent for resistance testing, 68% had at least one nucleoside reverse transcriptase inhibitor (NRTI) mutation, with M184V being the most common (62%) and with 48% having thymidine analogue mutations. Moreover, 72% had at least one non-nucleoside reverse transcriptase inhibitor (NNRTI) mutation and 23% had three or more NNRTI mutations. Both adherence measures were significantly associated with VL (P < 0.001). Suboptimal adherence was significantly associated with resistance mutations (P < 0.02). The findings illustrate for the first time the strong association between suboptimal adherence, treatment failure and drug resistance to first-line HAART in India. The predictive value of standard adherence measures was improved by including treatment interruption data. The observed mutations can jeopardise future treatment options, especially in light of limited access to second-line treatments. To develop effective adherence interventions, research is needed to examine culturally-specific reasons for treatment interruptions.
本研究旨在探讨印度班加罗尔接受高效抗逆转录病毒治疗（HAART）的门诊患者的依从性、病毒载量（VL）和耐药性之间的关系。共招募了 552 名门诊患者，并对所有研究参与者进行了 VL 检测。对 VL≥1000 拷贝/ml 的 92 名参与者进行了 HIV-1 基因型耐药性检测。耐药突变的解释根据斯坦福数据库进行。通过自我报告评估过去一个月的依从性和>48 小时的治疗中断。基线时，34 名参与者（6%）报告过去一个月的依从性<95%，110 名参与者（20%）报告>48 小时的治疗中断。将这两种依从性测量方法结合起来，22%的参与者被归类为“依从性不理想”。共有 24%的研究参与者（n=132）检测到可检测的 VL。在 92 份送检的耐药性检测样本中，68%至少有一种核苷逆转录酶抑制剂（NRTI）突变，其中 M184V 最为常见（62%），有 48%存在胸苷类似物突变。此外，72%至少有一种非核苷逆转录酶抑制剂（NNRTI）突变，23%有三种或更多的 NNRTI 突变。两种依从性测量均与 VL 显著相关（P<0.001）。依从性不理想与耐药突变显著相关（P<0.02）。这些发现首次表明，在印度，依从性不理想、治疗失败和对一线 HAART 的耐药性之间存在很强的关联。通过包括治疗中断数据，标准依从性测量的预测价值得到了提高。观察到的突变可能危及未来的治疗选择，尤其是在二线治疗途径有限的情况下。为了制定有效的依从性干预措施，需要研究特定文化背景下导致治疗中断的原因。
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