Pham Quang Duy, Huynh Thu Khanh Hoang, Luong Tram Thu, Tran Ton, Vu Thinh Xuan, Truong Lien Xuan Thi
Surveillance and Evaluation Program for Public Health, The Kirby Institute, University of New South Wales, Sydney, Australia.
HIV Clin Trials. 2013 Jan-Feb;14(1):34-44. doi: 10.1310/hct1401-34.
BACKGROUND & OBJECTIVES: Little is known about HIV-1 drug resistance (HIVDR) in people failing first-line highly active antiretroviral therapy (HAART) in Vietnam. The aim of this study was to investigate the frequency of HIV-1 drug resistance mutations (DRMs) and determine correlates of acquiring genotypic HIVDR among Vietnamese adults (age ≥ 18) who met the immunological or clinical criteria of first-line HAART failure according to the guidelines of the World Health Organization (WHO).
A total of 138 individuals participated in a descriptive study in Ho Chi Minh City between 2006 and 2009. Blood samples were collected for performing HIV-1 viral load (VL) and genotyping for specimens with VL ≥ 1,000 copies/mL. Stanford algorithm was used to interpret DRMs and multivariate analyses were performed to investigate predictors of HIVDR acquisition.
Of the study population, most participants failed either stavudine/lamivudine/nevirapine or stavudine/lamivudine/efavirenz (116 individuals). Up to 51 people obtained a VL <1,000 copies/mL. Among 87 participating individuals with VL ≥1,000 copies/mL, 11 people still harbored a wild-type strain, while 76 participants harbored a HIV-1 drug-resistant strain (2 of which were against protease inhibitors); common DRMs were M184I/V (74%), Y181I/C/V (39%), G190A/S (32%), T215Y/F (32%), and K103N (31%). The proportions of K65R, Q151M, and T69 insertion were 13%, 11%, and 5%, respectively. Being antiretroviral-exposed before initiating first-line HAART in a public and free-of-charge outpatient clinic, having nonadherence to first-line HAART, per 12-month increase of duration on first-line HAART, and having clinical failure criteria were significantly associated with a genotypic HIVDR acquisition.
In the absence of VL for the population with WHO immunological/ clinical treatment failure criteria, a large proportion of people still achieved a VL <1,000 copies/mL, while a high prevalence of HIVDR was observed in those with VL ≥1,000 copies/mL. Thus, VL monitoring should be implemented now for the HAART-treated population in Vietnam.
越南接受一线高效抗逆转录病毒治疗（HAART）失败的人群中，对HIV-1耐药性（HIVDR）的了解甚少。本研究旨在调查HIV-1耐药突变（DRM）的频率，并确定符合世界卫生组织（WHO）一线HAART失败免疫或临床标准的越南成年人（年龄≥18岁）中获得基因型HIVDR的相关因素。
2006年至2009年期间，共有138人在胡志明市参与了一项描述性研究。采集血样以检测HIV-1病毒载量（VL），并对VL≥1000拷贝/mL的样本进行基因分型。采用斯坦福算法解释DRM，并进行多变量分析以研究HIVDR获得的预测因素。
在研究人群中，大多数参与者一线治疗方案为司他夫定/拉米夫定/奈韦拉平或司他夫定/拉米夫定/依非韦伦治疗失败（116人）。多达51人病毒载量<1000拷贝/mL。在87名VL≥1000拷贝/mL的参与者中，11人仍携带野生型毒株，而76名参与者携带HIV-1耐药毒株（其中2人对蛋白酶抑制剂耐药）；常见的DRM为M184I/V（74%）、Y181I/C/V（39%）、G190A/S（32%）、T215Y/F（32%）和K103N（31%）。K65R、Q151M和T69插入的比例分别为13%、11%和5%。在公立免费门诊开始一线HAART之前曾接受过抗逆转录病毒治疗、未坚持一线HAART治疗、一线HAART治疗时间每增加12个月以及符合临床失败标准与获得基因型HIVDR显著相关。
对于符合WHO免疫/临床治疗失败标准的人群，在未检测病毒载量的情况下，仍有很大比例的人病毒载量<1000拷贝/mL，而在病毒载量≥1000拷贝/mL的人群中观察到HIVDR的高流行率。因此，越南应立即对接受HAART治疗的人群实施病毒载量监测。
