Assoumou L, Charpentier C, Recordon-Pinson P, Grudé M, Pallier C, Morand-Joubert L, Fafi-Kremer S, Krivine A, Montes B, Ferré V, Bouvier-Alias M, Plantier J-C, Izopet J, Trabaud M-A, Yerly S, Dufayard J, Alloui C, Courdavault L, Le Guillou-Guillemette H, Maillard A, Amiel C, Vabret A, Roussel C, Vallet S, Guinard J, Mirand A, Beby-Defaux A, Barin F, Allardet-Servent A, Ait-Namane R, Wirden M, Delaugerre C, Calvez V, Chaix M-L, Descamps D, Reigadas S
Sorbonne Universités, UPMC Univ. Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013 Paris, France.
INSERM UMR1137, IAME Université Paris Diderot Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Laboratoire Associé au Centre National de Référence du VIH-Résistance aux Antirétroviraux, Paris, France.
J Antimicrob Chemother. 2017 Jun 1;72(6):1769-1773. doi: 10.1093/jac/dkx042.
Surveillance of HIV-1 resistance in treated patients with a detectable viral load (VL) is important to monitor, in order to assess the risk of spread of resistant viruses and to determine the proportion of patients who need new antiretroviral drugs with minimal cross-resistance.
The HIV-1 protease and reverse transcriptase (RT) and integrase genes were sequenced in plasma samples from 782 consecutive patients on failing antiretroviral regimens, seen in 37 specialized centres in 2014. The genotyping results were interpreted using the ANRS v24 algorithm. Prevalence rates were compared with those obtained during a similar survey conducted in 2009.
The protease and RT sequences were obtained in 566 patients, and the integrase sequence in 382 patients. Sequencing was successful in 60%, 78%, 78% and 87% of patients with VLs of 51-200, 201-500, 501-1000 and >1000 copies/mL, respectively. Resistance to at least one antiretroviral drug was detected in 56.3% of samples. Respectively, 3.9%, 8.7%, 1.5% and 3.4% of patients harboured viruses that were resistant to any NRTI, NNRTI, PI and integrase inhibitor (INI). Resistance rates were lower in 2014 than in 2009. Resistance was detected in 48.5% of samples from patients with a VL between 51 and 200 copies/mL.
In France in 2014, 90.0% of patients in AIDS care centres were receiving antiretroviral drugs and 12.0% of them had VLs >50 copies/mL. Therefore, this study suggests that 6.7% of treated patients in France might transmit resistant strains. Resistance testing may be warranted in all treated patients with VL > 50 copies/mL.
对病毒载量（VL）可检测的接受治疗的患者进行HIV-1耐药性监测很重要，以便评估耐药病毒传播的风险，并确定需要使用交叉耐药性最小的新型抗逆转录病毒药物的患者比例。
对2014年在37个专科中心就诊的782例连续接受抗逆转录病毒治疗方案但治疗失败的患者的血浆样本中的HIV-1蛋白酶、逆转录酶（RT）和整合酶基因进行测序。使用ANRS v24算法解释基因分型结果。将患病率与2009年进行的类似调查中获得的患病率进行比较。
566例患者获得了蛋白酶和RT序列，382例患者获得了整合酶序列。病毒载量为51-200、201-500、501-1000和>1000拷贝/mL的患者中，测序成功率分别为60%、78%、78%和87%。56.3%的样本检测到对至少一种抗逆转录病毒药物耐药。分别有3.9%、8.7%、1.5%和3.4%的患者携带对任何核苷类逆转录酶抑制剂（NRTI）、非核苷类逆转录酶抑制剂（NNRTI）、蛋白酶抑制剂（PI）和整合酶抑制剂（INI）耐药的病毒。2014年的耐药率低于2009年。在病毒载量为51至200拷贝/mL的患者中，48.5%的样本检测到耐药。
2014年在法国，艾滋病护理中心90.0%的患者正在接受抗逆转录病毒药物治疗，其中12.0%的患者病毒载量>50拷贝/mL。因此，本研究表明法国6.7%的接受治疗的患者可能传播耐药毒株。对于所有病毒载量>50拷贝/mL的接受治疗的患者，可能有必要进行耐药性检测。
