von Braun Amrei, Sekaggya-Wiltshire Christine, Scherrer Alexandra U, Magambo Brian, Kambugu Andrew, Fehr Jan, Castelnuovo Barbara
Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
AIDS Res Ther. 2017 Jan 5;14(1):1. doi: 10.1186/s12981-016-0128-5.
This cross-sectional study took place in the integrated tuberculosis (TB) clinic of a large outpatient clinic for HIV-infected patients in Kampala, Uganda. The purpose of this study was to describe the proportion of TB/HIV co-infected adults with virological failure, type and frequency of HIV drug resistance-associated mutations, and the proportion of patients with suboptimal efavirenz levels.
HIV-1 plasma viral loads, CD4 cell count measurements, and efavirenz serum concentrations were done in TB/HIV co-infected adults. Genotypic resistance testing was performed in case of confirmed virological failure.
After a median time on ART of 6 months, virological failure was found in 22/152 patients (14.5%). Of 147 participants with available efavirenz serum concentration, 26 (17.6%) had at least one value below the reference range, including 20/21 (95.2%) patients with confirmed virological failure. Genotypic resistance testing was available for 16/22 (72.7%) patients, of which 15 (93.8%) had at least one major mutation, most commonly M184V (81.2%) and K103NS (68.8%).
We found a high proportion of TB/HIV co-infected patients with virological failure, the majority of which had developed relevant resistance-mutations after a median time on anti-retroviral treatment (ART) of 6 months. Virological monitoring should be prioritized in TB/HIV co-infected patients in resource-limited settings.
本横断面研究在乌干达坎帕拉一家大型门诊艾滋病毒感染患者综合结核病诊所开展。本研究的目的是描述结核病/艾滋病毒合并感染成人中病毒学失败的比例、艾滋病毒耐药相关突变的类型和频率，以及依非韦伦水平未达最佳的患者比例。
对结核病/艾滋病毒合并感染的成人进行了HIV-1血浆病毒载量、CD4细胞计数测量和依非韦伦血清浓度检测。在确诊病毒学失败的情况下进行基因型耐药检测。
在接受抗逆转录病毒治疗（ART）的中位时间为6个月后，152例患者中有22例（14.5%）出现病毒学失败。在147名有依非韦伦血清浓度数据的参与者中，26例（17.6%）至少有一个值低于参考范围，其中20/21例（95.2%）确诊为病毒学失败。16/（22例）患者（72.7%）可进行基因型耐药检测，其中15例（93.8%）至少有一个主要突变，最常见的是M184V（81.2%）和K103NS（68.8%）。
我们发现结核病/艾滋病毒合并感染患者中病毒学失败的比例很高，其中大多数患者在接受抗逆转录病毒治疗（ART）的中位时间为6个月后出现了相关耐药突变。在资源有限的环境中，应优先对结核病/艾滋病毒合并感染患者进行病毒学监测。
