Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.
Rev Panam Salud Publica. 2011 Dec;30(6):641-8. doi: 10.1590/s1020-49892011001200024.
To assess human immunodeficiency virus (HIV) diversity and the prevalence of transmitted drug resistance (TDR) in Guatemala.
One hundred forty-five antiretroviral treatment-naïve patients referred to the Roosevelt Hospital in Guatemala City were enrolled from October 2010 to March 2011. Plasma HIV pol sequences were obtained and TDR was assessed with the Stanford algorithm and the World Health Organization (WHO) TDR surveillance mutation list.
HIV subtype B was highly prevalent in Guatemala (96.6%, 140/145), and a 2.8% (4/145) prevalence of BF1 recombinants and 0.7% (1/145) prevalence of subtype C viruses were found. TDR prevalence for the study period was 8.3% (12/145) with the Stanford database algorithm (score > 15) and the WHO TDR surveillance mutation list. Most TDR cases were associated with non-nucleoside reverse transcriptase inhibitors (NNRTIs) (83.3%, 10/12); a low prevalence of nucleoside reverse transcriptase inhibitors and protease inhibitors was observed in the cohort (< 1% for both families). Low selection of antiretroviral drug resistance mutations was found, except for NNRTI-associated mutations. Major NNRTI mutations such as K101E, K103N, and E138K showed higher frequencies than expected in ART-naïve populations. Higher literacy was associated with a greater risk of TDR (odds ratio 4.14, P = 0.0264).
This study represents one of the first efforts to describe HIV diversity and TDR prevalence and trends in Guatemala. TDR prevalence in Guatemala was at the intermediate level. Most TDR cases were associated with NNRTIs. Further and continuous TDR surveillance is necessary to gain more indepth knowledge about TDR spread and trends in Guatemala and to optimize treatment outcomes in the country.
评估危地马拉的人类免疫缺陷病毒（HIV）多样性和传播耐药性（TDR）的流行率。
2010 年 10 月至 2011 年 3 月，从危地马拉城罗斯福医院招募了 145 名接受抗逆转录病毒治疗的初治患者。获得血浆 HIV pol 序列，并使用斯坦福算法和世界卫生组织（WHO）TDR 监测突变列表评估 TDR。
在危地马拉，HIV 亚型 B 高度流行（96.6%，140/145），发现 BF1 重组体的流行率为 2.8%（4/145），C 型病毒的流行率为 0.7%（1/145）。研究期间，斯坦福数据库算法（评分>15）和世卫组织 TDR 监测突变列表显示，TDR 的流行率为 8.3%（12/145）。大多数 TDR 病例与非核苷类逆转录酶抑制剂（NNRTI）相关（83.3%，10/12）；队列中核苷类逆转录酶抑制剂和蛋白酶抑制剂的流行率较低（两种家族均<1%）。除 NNRTI 相关突变外，发现抗逆转录病毒药物耐药突变的选择率较低。在 ART 初治人群中，K101E、K103N 和 E138K 等主要 NNRTI 突变的频率高于预期。较高的文化程度与 TDR 的风险增加相关（比值比 4.14，P=0.0264）。
本研究代表了首次在危地马拉描述 HIV 多样性和 TDR 流行率和趋势的努力之一。危地马拉的 TDR 流行率处于中等水平。大多数 TDR 病例与 NNRTIs 相关。需要进一步和持续的 TDR 监测，以更深入地了解 TDR 在危地马拉的传播和趋势，并优化该国的治疗结果。
