[危地马拉罗斯福医院2008 - 2012年病毒学治疗失败患者中HIV - 1对抗逆转录病毒药物的耐药模式]

[Patterns of HIV-1 resistance to antiretroviral drugs in patients with virologic failure: Roosevelt Hospital, Guatemala 2008-2012].

作者信息

Mendizábal-Burastero Ricardo, Girón-Callejas Amalia C, Rodas-Cruz Jorge A, Pinzón Rodolfo, Romero M Lisbeth, Boror E Marisol, Mejía-Villatoro Carlos R

出版信息

Rev Chilena Infectol. 2013 Dec;30(6):630-7. doi: 10.4067/S0716-10182013000600010.

DOI:10.4067/S0716-10182013000600010

PMID:24522307

Abstract

OBJECTIVE

To assess the secondary resistance patterns of HIV-1to Anti-Retroviral Agents drugs (ART) in patients with virological failure in the main HIV care center in Guatemala.

METHODS

Using the Stanford HIV Database,HIV pol sequences were analyzed to obtain resistance patterns in patients with first-failure to ART or multiple-failures (2 or more regimens failed), from 2008 to 2012. Proportions and odds ratio (OR) with 95% confidence intervals (95%CI) were calculated.

RESULTS

83% (43) in the first-failure and 75% (30) in multiple-failures had resistance. The highest frequency (70%)of resistance was found in the non-nucleoside-inhibitors ART family. 44% (42) showed resistance to two ART families and 4% (4) to the three families. First-failure patients had higher risk of nucleoside-inhibitor resistance (OR:3.0, 95%CI 1.29-6.98) and multidrug resistance (OR:4.94, 95%CI 1.98-12.32). Most frequent mutations were: M184V, K103N and K65R (71, 50 and 22%, respectively). 70% of patients with first-failure were resistant to at least one of the drugs used as second ART in Guatemala (ABC, ddI or AZT).

CONCLUSIONS

The high level of HIV-1 resistance to ART observed, suggest the need to amend the current second line regimen treatments in Guatemala and the importance of viral genotyping in all patients with first-failure to ART.

摘要

目的

评估危地马拉主要艾滋病护理中心病毒学治疗失败患者中HIV-1对抗逆转录病毒药物（ART）的二线耐药模式。

方法

利用斯坦福HIV数据库，分析2008年至2012年首次接受ART治疗失败或多次治疗失败（2种或更多方案失败）患者的HIV pol序列，以获得耐药模式。计算比例和比值比（OR）以及95%置信区间（95%CI）。

结果

首次治疗失败患者中83%（43例）有耐药性，多次治疗失败患者中75%（30例）有耐药性。在非核苷类抑制剂ART家族中发现的耐药频率最高（70%）。44%（42例）对两个ART家族耐药，4%（4例）对三个家族耐药。首次治疗失败患者对核苷类抑制剂耐药（OR：3.0，95%CI 1.29 - 6.98）和多药耐药（OR：4.94，95%CI 1.98 - 12.32）的风险更高。最常见的突变是：M184V、K103N和K65R（分别为71%、50%和22%）。70%的首次治疗失败患者对危地马拉用作二线ART的至少一种药物（ABC、ddI或AZT）耐药。