National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy.
University of Rome Tor Vergata, Rome, Italy.
J Antimicrob Chemother. 2017 Oct 1;72(10):2837-2845. doi: 10.1093/jac/dkx231.
Transmitted drug-resistance (TDR) remains a critical aspect for the management of HIV-1-infected individuals. Thus, studying the dynamics of TDR is crucial to optimize HIV care.
In total, 4323 HIV-1 protease/reverse-transcriptase sequences from drug-naive individuals diagnosed in north and central Italy between 2000 and 2014 were analysed. TDR was evaluated over time. Maximum-likelihood and Bayesian phylogenetic trees with bootstrap and Bayesian-probability supports defined transmission clusters.
Most individuals were males (80.2%) and Italian (72.1%), with a median (IQR) age of 37 (30-45) years. MSM accounted for 42.2% of cases, followed by heterosexuals (36.4%). Non-B subtype infections accounted for 30.8% of the overall population and increased over time (<2005-14: 19.5%-38.5%, P < 0.0001), particularly among Italians (<2005-14: 6.5%-28.8%, P < 0.0001). TDR prevalence was 8.8% and increased over time in non-B subtypes (<2005-14: 2%-7.1%, P = 0.018). Overall, 467 transmission clusters (involving 1207 individuals; 27.9%) were identified. The prevalence of individuals grouping in transmission clusters increased over time in both B (<2005-14: 12.9%-33.5%, P = 0.001) and non-B subtypes (<2005-14: 18.4%-41.9%, P = 0.006). TDR transmission clusters were 13.3% within the overall cluster observed and dramatically increased in recent years (<2005-14: 14.3%-35.5%, P = 0.005). This recent increase was mainly due to non-B subtype-infected individuals, who were also more frequently involved in large transmission clusters than those infected with a B subtype [median number of individuals in transmission clusters: 7 (IQR 6-19) versus 4 (3-4), P = 0.047].
The epidemiology of HIV transmission changed greatly over time; the increasing number of transmission clusters (sometimes with drug resistance) shows that detection and proper treatment of the multi-transmitters is a major target for controlling HIV spread.
传播耐药性（TDR）仍然是管理 HIV-1 感染者的一个关键方面。因此，研究 TDR 的动态对于优化 HIV 护理至关重要。
本研究共分析了 2000 年至 2014 年间在意大利北部和中部诊断的 4323 例未经药物治疗的 HIV-1 蛋白酶/逆转录酶序列。随着时间的推移评估 TDR。最大似然和贝叶斯系统发育树，带有自举和贝叶斯概率支持，定义了传播簇。
大多数个体为男性（80.2%）和意大利人（72.1%），中位（IQR）年龄为 37（30-45）岁。男男性行为者占病例的 42.2%，其次是异性恋者（36.4%）。非 B 亚型感染占总人群的 30.8%，且呈上升趋势（<2005-14 年：19.5%-38.5%，P<0.0001），特别是在意大利人中（<2005-14 年：6.5%-28.8%，P<0.0001）。TDR 患病率呈上升趋势，非 B 亚型中为 8.8%，且呈上升趋势（<2005-14 年：2%-7.1%，P=0.018）。总体而言，确定了 467 个传播簇（涉及 1207 人；27.9%）。B 亚型（<2005-14 年：12.9%-33.5%，P=0.001）和非 B 亚型（<2005-14 年：18.4%-41.9%，P=0.006）中分组在传播簇中的个体的患病率随着时间的推移而增加。在总体观察到的簇中，TDR 传播簇占 13.3%，近年来急剧增加（<2005-14 年：14.3%-35.5%，P=0.005）。这种最近的增加主要是由于非 B 亚型感染者，与感染 B 亚型的个体相比，他们更频繁地参与大型传播簇[传播簇中的个体中位数（IQR）：7（6-19）比 4（3-4），P=0.047]。
HIV 传播的流行病学随时间发生了重大变化；传播簇数量的增加（有时伴有耐药性）表明，检测和适当治疗多传播者是控制 HIV 传播的主要目标。
