Loubet Paul, Charpentier Charlotte, Visseaux Benoit, Borbor Abraham, Nuta Cecilia, Adu Eric, Chapplain Jean-Marc, Baysah Maima, Tattevin Pierre, Yazdanpanah Yazdan, Descamps Diane
Ensemble pour une Solidarité Thérapeutique en Réseau (GIP-ESTHER), Paris, France INSERM, IAME, UMR 1137, F-75018 Paris, France AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, F-75018 Paris, France.
INSERM, IAME, UMR 1137, F-75018 Paris, France Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Virologie, F-75018 Paris, France
J Antimicrob Chemother. 2015;70(6):1881-4. doi: 10.1093/jac/dkv030. Epub 2015 Feb 18.
To assess the prevalence of acquired drug resistance in HIV-1-infected patients living in Monrovia, Liberia, who had clinical and/or immunological failure of first-line ART according to WHO criteria.
Patients receiving ART for >1 year with clinical and/or immunological failure were included. Sequencing of protease and reverse transcriptase regions was performed using Agence Nationale de Recherche sur le SIDA et les hépatites virales (ANRS) procedures and sequences were interpreted using the ANRS resistance algorithm.
Ninety patients were enrolled. They had been receiving ART for a median time of 42 months and half were receiving zidovudine/lamivudine/nevirapine. Seventy-five per cent of patients were infected with CRF02_AG. Twenty-seven per cent of patients displayed a plasma viral load <50 copies/mL. Among the 66 patients with detectable viraemia, the median viral load was 4.7 log10 copies/mL (IQR = 3.0-5.6). The prevalence of NRTI and NNRTI resistance-associated mutations (RAMs) was 63% and 71%, respectively; and the median number of NRTI and NNRTI RAMs was 2 and 3, respectively. Two patients (4%) displayed viruses with PI RAMs. Regarding NRTI drug resistance, 29%, 38%, 63%, 29% and 25% of patients had viruses resistant to zidovudine, stavudine, lamivudine/emtricitabine, abacavir and tenofovir, respectively. Regarding the NNRTI drug class, 56%, 65%, 33% and 42% of patients had viruses resistant to efavirenz, nevirapine, etravirine and rilpivirine, respectively.
The high prevalence of acquired drug resistance in patients followed in two centres of the Liberian capital city, documented after a median of 3 years on a first-line ART regimen, jeopardizes the activity of second-line regimens and highlights the need for virological monitoring in these settings.
评估根据世界卫生组织标准，在利比里亚蒙罗维亚接受一线抗逆转录病毒治疗（ART）出现临床和/或免疫失败的HIV-1感染患者中获得性耐药的流行情况。
纳入接受ART超过1年且出现临床和/或免疫失败的患者。使用法国国家艾滋病和病毒性肝炎研究机构（ANRS）的程序对蛋白酶和逆转录酶区域进行测序，并使用ANRS耐药算法解读序列。
共纳入90例患者。他们接受ART的中位时间为42个月，其中一半患者接受齐多夫定/拉米夫定/奈韦拉平治疗。75%的患者感染了CRF02_AG毒株。27%的患者血浆病毒载量<50拷贝/毫升。在66例可检测到病毒血症的患者中，中位病毒载量为4.7 log10拷贝/毫升（四分位间距=3.0-5.6）。核苷类逆转录酶抑制剂（NRTI）和非核苷类逆转录酶抑制剂（NNRTI）耐药相关突变（RAMs）的流行率分别为63%和71%；NRTI和NNRTI RAMs的中位数分别为2和3。2例患者（4%）的病毒显示出蛋白酶抑制剂（PI）RAMs。关于NRTI耐药情况，分别有29%、38%、63%、29%和25%的患者病毒对齐多夫定、司他夫定、拉米夫定/恩曲他滨、阿巴卡韦和替诺福韦耐药。关于NNRTI药物类别，分别有56%、65%、33%和42%的患者病毒对依非韦伦、奈韦拉平、依曲韦林和利匹韦林耐药。
在利比里亚首都两个中心接受治疗的患者中，一线ART方案治疗中位3年后记录到的获得性耐药高流行率，危及二线方案的有效性，并凸显了在这些环境中进行病毒学监测的必要性。
