Snedecor Sonya J, Sudharshan Lavanya, Nedrow Katherine, Bhanegaonkar Abhijeet, Simpson Kit N, Haider Seema, Chambers Richard, Craig Charles, Stephens Jennifer
1 Pharmerit International , Bethesda, Maryland.
AIDS Res Hum Retroviruses. 2014 Aug;30(8):753-68. doi: 10.1089/AID.2013.0262. Epub 2014 Jul 8.
The prevalence of HIV drug resistance varies with geographic location, year, and treatment exposure. This study generated yearly estimates of nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance in treatment-naive (TN) and treatment-experienced (TE) patients in the United States (US), Europe (EU), and Canada. Studies reporting NNRTI resistance identified in electronic databases and 11 conferences were analyzed in three groups: (1) TN patients in one of four geographic regions [US, Canada, EU countries with larger surveillance networks ("EU1"), and EU countries with fewer data ("EU2")]; (2) TE patients from any region; and (3) TN patients failing NNRTI-based treatments in clinical trials. Analysis data included 158 unique studies from 22 countries representing 84 cohorts of TN patients, 21 cohorts of TE patients, and 8 trials reporting resistance at failure. From 1995 to 2000, resistance prevalence in TN patients increased in US and EU1 from 3.1% to 7.5% and 0.8% to 3.6%, respectively. Resistance in both regions stabilized in 2006 onward. Little resistance was identified in EU2 before 2000, and increased from 2006 (5.0%) to 2010 (13.7%). One TN Canadian study was identified and reported resistance of 8.1% in 2006. Half of TN clinical trial patients had resistance after treatment failure at weeks 48-144. Resistance in TE patients increased from 1998 (10.1%) to 2001 (44.0%), then decreased after 2004. Trends in NNRTI resistance among TN patients show an increased burden in the US and some EU countries compared to others. These findings signify a need for alternate first-line treatments in some regions.
艾滋病毒耐药性的流行情况因地理位置、年份和治疗暴露情况而异。本研究对美国、欧洲和加拿大初治（TN）和经治（TE）患者的非核苷类逆转录酶抑制剂（NNRTI）耐药性进行了年度估算。对在电子数据库和11次会议中报告的NNRTI耐药性研究进行了三组分析：（1）四个地理区域之一的初治患者[美国、加拿大、监测网络较大的欧盟国家（“欧盟1”）和数据较少的欧盟国家（“欧盟2”）]；（2）来自任何地区的经治患者；（3）在临床试验中接受基于NNRTI治疗失败的初治患者。分析数据包括来自22个国家的158项独特研究，代表84个初治患者队列、21个经治患者队列以及8项报告治疗失败时耐药性的试验。1995年至2000年，美国和欧盟1初治患者的耐药率分别从3.1%升至7.5%和从0.8%升至3.6%。2006年起这两个地区的耐药率趋于稳定。2000年前欧盟2几乎未发现耐药情况，2006年（5.0%）至2010年（13.7%）有所增加。一项加拿大初治患者研究显示2006年耐药率为8.1%。初治临床试验患者中有一半在第48 - 144周治疗失败后出现耐药。经治患者的耐药率从1998年（10.1%）升至2001年（44.0%），2004年后下降。与其他地区相比，美国和部分欧盟国家初治患者中NNRTI耐药性的趋势表明负担有所增加。这些发现表明一些地区需要替代一线治疗方案。
