未接受过抗逆转录病毒治疗和接受过抗逆转录病毒治疗的 HIV-1 患者的脑脊液中比血浆中存在更多耐药病毒。
Antiretroviral-naive and -treated HIV-1 patients can harbour more resistant viruses in CSF than in plasma.
机构信息
Sorbonne Universités, UPMC Université de Paris, 06-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75005 Paris, France INSERM-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Laboratoire de Virologie, F-75013 Paris, France
IAME, UMR 1137-Université Paris Diderot, Sorbonne Paris Cité, INSERM, F-75018 Paris, France AP-HP, Hôpital Bichat, Laboratoire de Virologie, F-75018 Paris, France.
出版信息
J Antimicrob Chemother. 2015 Feb;70(2):566-72. doi: 10.1093/jac/dku419. Epub 2014 Oct 25.
OBJECTIVES
The neurological disorders in HIV-1-infected patients remain prevalent. The HIV-1 resistance in plasma and CSF was compared in patients with neurological disorders in a multicentre study.
METHODS
Blood and CSF samples were collected at time of neurological disorders for 244 patients. The viral loads were >50 copies/mL in both compartments and bulk genotypic tests were realized.
RESULTS
On 244 patients, 89 and 155 were antiretroviral (ARV) naive and ARV treated, respectively. In ARV-naive patients, detection of mutations in CSF and not in plasma were reported for the reverse transcriptase (RT) gene in 2/89 patients (2.2%) and for the protease gene in 1/89 patients (1.1%). In ARV-treated patients, 19/152 (12.5%) patients had HIV-1 mutations only in the CSF for the RT gene and 30/151 (19.8%) for the protease gene. Two mutations appeared statistically more prevalent in the CSF than in plasma: M41L (P=0.0455) and T215Y (P=0.0455).
CONCLUSIONS
In most cases, resistance mutations were present and similar in both studied compartments. However, in 3.4% of ARV-naive and 8.8% of ARV-treated patients, the virus was more resistant in CSF than in plasma. These results support the need for genotypic resistance testing when lumbar puncture is performed.
目的
HIV-1 感染患者的神经紊乱仍然普遍存在。在一项多中心研究中，比较了有神经紊乱的患者血浆和脑脊液中的 HIV-1 耐药情况。
方法
在 244 名有神经紊乱的患者中，分别在发病时采集了血液和脑脊液样本。这两个部位的病毒载量均>50 拷贝/mL，并进行了大量的基因分型检测。
结果
在 244 名患者中，89 名和 155 名分别为未接受抗逆转录病毒治疗（ARV）和接受 ARV 治疗的患者。在未接受 ARV 治疗的患者中，2 名（2.2%）患者的逆转录酶（RT）基因和 1 名（1.1%）患者的蛋白酶基因在脑脊液中检测到突变，但在血浆中未检测到。在接受 ARV 治疗的患者中，19 名（12.5%）患者的 RT 基因和 30 名（19.8%）患者的蛋白酶基因的 HIV-1 突变仅存在于脑脊液中。有两种突变在脑脊液中的出现频率明显高于血浆：M41L（P=0.0455）和 T215Y（P=0.0455）。
结论
在大多数情况下，耐药突变在两个研究部位均存在且相似。然而，在 3.4%的未接受 ARV 治疗的患者和 8.8%的接受 ARV 治疗的患者中，病毒在脑脊液中的耐药性比在血浆中更高。这些结果支持在进行腰椎穿刺时进行基因耐药性检测的必要性。
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