Buchacz Kate, Young Benjamin, Palella Frank J, Armon Carl, Brooks John T
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
APEX Family Medicine, Denver, CO, USA International Association of Providers of AIDS Care, Washington, DC, USA.
J Antimicrob Chemother. 2015 Aug;70(8):2337-46. doi: 10.1093/jac/dkv120. Epub 2015 May 15.
Monitoring antiretroviral drug resistance can inform treatment recommendations; however, there are few such data from US patients before they initiate ART.
We analysed data from HIV Outpatient Study (HOPS) participants from nine US HIV clinics who were diagnosed with HIV infection during 1999-2011. Using the IAS-USA December 2010 guidelines, we assessed the frequency of major drug resistance mutations (mDRMs) related to antiretroviral agents in viral isolates from patients who underwent commercial genotypic testing (GT) for resistance before initiating ART. We employed general linear regression models to assess factors associated with having undergone GT, and then factors associated with having mDRM.
Among 1531 eligible patients, 758 (49.5%) underwent GT before first ART, increasing from 15.5% in 1999-2002 to 75.9% in 2009-11 (P < 0.001). GT was carried out a median of 1.2 months after the diagnosis of HIV. In adjusted regression analyses, patients with pre-ART CD4+ T lymphocyte counts ≥200 cells/mm(3) or with HIV RNA levels >5.0 log10 copies/mL and those with a first HOPS visit in 2006 or later were significantly (P < 0.05) more likely to have undergone GT. Of the 758 patients, 114 (15.0%) had mDRMs; mutations relating to NRTIs, NNRTIs and PIs were present in 8.0%, 7.1% and 2.6%, respectively. There was no temporal change in the frequency of mDRM, and mDRMs were associated with an HIV RNA level <4.0 log10 copies/mL.
During 1999-2011, GT use among antiretroviral-naive patients became more common, but a quarter of patients in recent years remained untested. The frequency of mDRMs remained stable over time at about 15%.
监测抗逆转录病毒药物耐药性可为治疗建议提供依据；然而，在美国患者开始抗逆转录病毒治疗（ART）之前，此类数据很少。
我们分析了来自美国9家HIV诊所的HIV门诊研究（HOPS）参与者的数据，这些参与者在1999年至2011年期间被诊断为HIV感染。根据2010年12月美国艾滋病学会（IAS-USA）指南，我们评估了在开始ART之前接受商业基因型检测（GT）以检测耐药性的患者的病毒分离物中与抗逆转录病毒药物相关的主要耐药突变（mDRM）的频率。我们采用一般线性回归模型来评估与接受GT相关的因素，然后评估与存在mDRM相关的因素。
在1531名符合条件的患者中，758名（49.5%）在首次ART之前接受了GT，从1999年至2002年的15.5%增加到2009年至2011年的75.9%（P<0.001）。GT在诊断HIV后中位数1.2个月进行。在调整后的回归分析中，ART前CD4+T淋巴细胞计数≥200个细胞/mm³或HIV RNA水平>5.0 log10拷贝/mL的患者以及2006年或之后首次就诊于HOPS的患者接受GT的可能性显著更高（P<0.05）。在758名患者中，114名（15.0%）有mDRM；与核苷类逆转录酶抑制剂（NRTIs）、非核苷类逆转录酶抑制剂（NNRTIs）和蛋白酶抑制剂（PIs）相关的突变分别占8.0%、7.1%和2.6%。mDRM的频率没有随时间变化，且mDRM与HIV RNA水平<4.0 log10拷贝/mL相关。
在1999年至2011年期间，未接受过抗逆转录病毒治疗的患者中GT的使用变得更加普遍，但近年来仍有四分之一的患者未接受检测。mDRM的频率随时间保持稳定，约为15%。
