Virology Department, Institute of Tropical Medicine Pedro Kourí, Autopista Novia del Mediodía Km 6, Marianao 13, Havana City, Cuba.
J Clin Virol. 2012 Dec;55(4):348-55. doi: 10.1016/j.jcv.2012.08.019. Epub 2012 Sep 13.
Emergence of HIV-1 drug resistance may limit the sustained benefits of antiretroviral therapy (ART) in settings with limited laboratory monitoring and drug options.
Surveillance of drug resistance and subtypes in HIV-1 patients failing ART in Cuba.
This study compiled data of ART-experienced HIV-1 patients attending a clinical center in Havana in 2003 and 2009-2011. The first period included results of a cross-sectional study, whereas in the second period genotyping was performed as part of routine care. Drug resistance mutations and levels were determined using HIVdb version 6.0.9.
Seventy-six percent received solely ART containing at least 3 drugs, of which 79.1% ever receiving unboosted protease inhibitors (PI). Patients from 2009 to 2011 were longer treated and exposed to more ART regimens. Subtype B (39%) and CRF19_cpx (18%) were the most prevalent genetic forms. Subtype distribution did not change significantly between both periods, except for BG recombinants that increased from 6% to 14%. Nucleoside reverse transcriptase inhibitor (NRTI), non-nucleoside RTI (NNRTI) and PI mutations were present in 69.5%, 54.8% and 44.4%. Full-class resistance (FCR) to NRTI, NNRTI, PI and multidrug resistance (MDR) were detected in 31.8%, 37.9%, 18.5% and 15.4%. FCR to NRTI, NNRTI, PI and MDR were present in 9.8%, 14.1%, 0%, 0% after first-line failure and in 19.8%, 20.8%, 2.9% and 2.9% after second-line failure.
Our study found a high prevalence of drug resistance and supports the need for appropriate laboratory monitoring in clinical practice and access to drug options in case of virological failure.
在实验室监测和药物选择有限的情况下，HIV-1 耐药的出现可能会限制抗逆转录病毒治疗（ART）的持续获益。
监测在古巴接受 ART 治疗失败的 HIV-1 患者的耐药情况和亚型。
本研究整理了 2003 年和 2009-2011 年在哈瓦那一家临床中心接受治疗的 HIV-1 经验丰富的患者的数据。第一个时期包括一项横断面研究的结果，而在第二个时期，基因分型作为常规护理的一部分进行。使用 HIVdb 版本 6.0.9 确定耐药突变和耐药水平。
76%的患者接受了至少含有 3 种药物的 ART 治疗，其中 79.1%的患者曾接受过未增强的蛋白酶抑制剂（PI）治疗。2009-2011 年的患者接受治疗的时间更长，接触的 ART 方案也更多。B 亚型（39%）和 CRF19_cpx（18%）是最常见的遗传形式。两个时期之间的亚型分布没有明显变化，除了 BG 重组体从 6%增加到 14%。核苷酸逆转录酶抑制剂（NRTI）、非核苷酸 RTIs（NNRTIs）和 PI 突变的存在率分别为 69.5%、54.8%和 44.4%。NRTI、NNRTI、PI 和多药耐药（MDR）的完全耐药（FCR）分别为 31.8%、37.9%、18.5%和 15.4%。一线治疗失败后，NRTI、NNRTI、PI 和 MDR 的 FCR 分别为 9.8%、14.1%、0%和 0%，二线治疗失败后，NRTI、NNRTI、PI 和 MDR 的 FCR 分别为 19.8%、20.8%、2.9%和 2.9%。
我们的研究发现耐药率很高，支持在临床实践中进行适当的实验室监测，并在病毒学失败时获得药物选择。
