Hospital Carlos III, Madrid, Spain.
J Antimicrob Chemother. 2013 Sep;68(9):1994-2002. doi: 10.1093/jac/dkt146. Epub 2013 Apr 29.
Limited data are available on resistance to etravirine, rilpivirine, darunavir and tipranavir in patients infected with HIV-1 non-B subtypes, in which natural polymorphisms at certain positions could influence the barrier and/or pathways to drug resistance.
FASTA format sequences from the reverse transcriptase and protease genes recorded within the Spanish Drug Resistance database (ResRIS) were examined.
From 8272 genotypes derived from 5930 different HIV-1 patients included in ResRIS, 5276 genotypes had complete treatment information. Overall, 85% were from antiretroviral-experienced subjects and 7.5% belonged to HIV-1 non-B subtypes: CRF02_AG, C, F and G being the most prevalent variants. For etravirine, only G190A was more prevalent in B than non-B subtypes, whereas V90I and V179E were more frequent in non-B than B subtypes. For rilpivirine, V108I and Y188I were more frequent in B than non-B subtypes, whereas V90I was more prevalent in non-B subtypes. Despite these differences, the overall prevalence of resistance did not differ significantly when comparing etravirine or rilpivirine in B versus non-B subtypes (11.3% versus 7.4%, P = 0.13, and 10.5% versus 7.4%, P = 0.23, respectively). Despite more frequent natural polymorphisms in non-B than B subtypes at tipranavir resistance positions, the prevalence of tipranavir resistance was greater in B than non-B subtypes (11% versus 4.3%, P = 0.004), reflecting a greater antiretroviral exposure in the former. Darunavir resistance did not differ significantly when comparing B and non-B subtypes (5.8% versus 5.5%, P = 0.998).
The rate of resistance to the most recently approved protease and non-nucleoside reverse transcriptase inhibitors is low in antiretroviral-experienced patients, regardless of the HIV-1 subtype.
在感染 HIV-1 非 B 亚型的患者中，针对依曲韦林、利匹韦林、达芦那韦和替拉那韦的耐药数据有限，在这些患者中，某些位置的天然多态性可能会影响耐药的屏障和/或途径。
检查了西班牙耐药数据库（ResRIS）中记录的逆转录酶和蛋白酶基因的 FASTA 格式序列。
从 ResRIS 中包含的 5930 名不同 HIV-1 患者的 8272 个基因型中，有 5276 个基因型具有完整的治疗信息。总体而言，85%的患者为抗逆转录病毒经验丰富的患者，7.5%的患者属于 HIV-1 非 B 亚型：CRF02_AG、C、F 和 G 是最常见的变异体。对于依曲韦林，只有 G190A 在 B 亚型中的发生率高于非 B 亚型，而 V90I 和 V179E 在非 B 亚型中的发生率高于 B 亚型。对于利匹韦林，V108I 和 Y188I 在 B 亚型中的发生率高于非 B 亚型，而 V90I 在非 B 亚型中的发生率较高。尽管存在这些差异，但在 B 亚型与非 B 亚型比较时，依曲韦林或利匹韦林的耐药总发生率无显著差异（11.3%比 7.4%，P=0.13；10.5%比 7.4%，P=0.23）。尽管非 B 亚型比 B 亚型在替拉那韦耐药位置的天然多态性更频繁，但 B 亚型的替拉那韦耐药率高于非 B 亚型（11%比 4.3%，P=0.004），这反映了前者接受了更多的抗逆转录病毒治疗。B 亚型和非 B 亚型比较时，达芦那韦耐药率无显著差异（5.8%比 5.5%，P=0.998）。
在抗逆转录病毒经验丰富的患者中，无论 HIV-1 亚型如何，最近批准的蛋白酶和非核苷类逆转录酶抑制剂的耐药率都很低。
