Pham Quang Duy, Do Nhan Thi, Le Yen Ngoc, Nguyen Thuong Vu, Nguyen Duc Bui, Huynh Thu Khanh Hoang, Bui Duong Duc, Van Khuu Nghia, Nguyen Phuc Duy, Luong Anh Que, Bui Hien Thu, Nguyen Hai Huu, McConnell Michelle, Nguyen Long Thanh, Zhang Lei, Truong Lien Xuan
Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam Surveillannce and Evaluation Program for Public Health, Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
Department of HIV Care and Treatment, Vietnam Authority of HIV/AIDS Control, Hanoi, Vietnam.
J Antimicrob Chemother. 2015 Mar;70(3):941-7. doi: 10.1093/jac/dku473. Epub 2014 Nov 27.
The objective of this study was to determine the prevalence and correlates of pretreatment drug resistance (PDR) to first-line antiretroviral drugs among people initiating therapy for HIV in Vietnam.
Blood was collected during November 2009 to October 2010 from people consecutively initiating ART in four purposively selected public outpatient clinics in three Vietnamese cities. At each study site, recruitment lasted for 6-10 months until the target sample size (range 120-130 individuals) had been reached. The viral load was measured in 501 samples; 490 samples (viral load ≥1000 copies/mL) were genotyped using a nucleotide population-based sequencing assay. Self-reported demographic and clinical data were elicited through interviews. We classified drug-resistance-associated mutations (DRMs) according to the 2009 WHO surveillance list.
DRMs were identified in 17/490 participants (3.5%; 95% CI 2.2%-5.5%). The prevalence of DRMs was 1.6% (8/490) against NRTIs, 1.6% (8/490) against NNRTIs and 0.8% (4/490) against PIs; three (0.6%) participants were resistant to both NRTIs and NNRTIs. The overall prevalence of PDR to first-line drugs was low [2.7% (13/490); 95% CI 1.6%-4.4%]. The prevalence of PDR to first-line drugs was greater among 198 HIV-infected participants who injected drugs than among 286 participants who reported risks for sexually acquired HIV (4.0% versus 1.4%, P = 0.079). Multivariable logistic regression analysis suggested that PDR to first-line drugs was significantly higher among people who injected drugs (OR = 3.94; 95% CI 1.13-13.68).
With low PDR, first-line ART may be effective in Vietnam and pretreatment genotyping may be unnecessary. Continuing strategies for the prevention and surveillance of antiretroviral resistance are important for maintaining a low prevalence of antiretroviral resistance in Vietnam. The association between resistance and injection drug use warrants further research.
本研究的目的是确定越南开始接受HIV治疗的人群中对一线抗逆转录病毒药物的治疗前耐药性（PDR）的流行情况及其相关因素。
2009年11月至2010年10月期间，从越南三个城市的四个有目的选择的公共门诊诊所中连续开始接受抗逆转录病毒治疗（ART）的人群中采集血液。在每个研究地点，招募持续6 - 10个月，直至达到目标样本量（范围为120 - 130人）。对501份样本进行了病毒载量检测；对490份样本（病毒载量≥1000拷贝/毫升）使用基于核苷酸群体的测序分析法进行基因分型。通过访谈获取自我报告的人口统计学和临床数据。我们根据2009年世界卫生组织监测清单对耐药相关突变（DRMs）进行分类。
在17/490名参与者（3.5%；95%置信区间2.2% - 5.5%）中鉴定出DRMs。对核苷类逆转录酶抑制剂（NRTIs）的DRMs流行率为1.6%（8/490），对非核苷类逆转录酶抑制剂（NNRTIs）的为1.6%（8/490），对蛋白酶抑制剂（PIs）的为0.8%（4/490）；三名（0.6%）参与者对NRTIs和NNRTIs均耐药。对一线药物的PDR总体流行率较低[2.7%（13/490）；95%置信区间1.6% - 4.4%]。在198名注射毒品的HIV感染者中，对一线药物的PDR流行率高于286名报告有性传播HIV风险者（4.0%对1.4%，P = 0.079）。多变量逻辑回归分析表明，注射毒品者对一线药物的PDR显著更高（比值比 = 3.94；95%置信区间1.13 - 13.68）。
由于PDR较低，一线抗逆转录病毒治疗在越南可能有效，治疗前基因分型可能没有必要。继续实施抗逆转录病毒耐药性的预防和监测策略对于在越南维持低抗逆转录病毒耐药率很重要。耐药性与注射毒品使用之间的关联值得进一步研究。
