Tsai Hung-Chin, Chen I-Tzu, Lee Susan Shin-Jung, Chen Yao-Shen
Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan,
Infect Drug Resist. 2018 Aug 3;11:1061-1071. doi: 10.2147/IDR.S165811. eCollection 2018.
Sparse data are available on the prevalence of resistance among HIV-1-infected patients with virological failure to a single-tablet regimen (STR). This study aimed to evaluate the prevalence of HIV genotypic drug resistance in HIV-1-infected patients with virological failure to STRs in southern Taiwan.
This retrospective study investigated drug resistance in patients with virological failure to STR from January 2016 to September 2017. Antiretroviral resistance mutations were defined using the 2017 International AIDS Society-USA HIV drug resistance algorithm, and drug resistance was compared using the HIVdb program of the Stanford University HIV Drug Resistance Database. Variables between resistance and non-resistance groups were compared.
Thirty-nine HIV-1-infected patients with treatment failure were tested for resistance, of whom 89% were infected by men who have sex with men. Subtype B HIV-1 strains were found in 90% of the patients. Eight patients were treatment naïve and initiated STRs, while 31 patients experienced treatment failure after switching to STRs. Eighty-seven percent of the patients harbored any of four classes of resistance (nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors (PIs), and integrase strand transfer inhibitors). The prevalence rates of nucleoside reverse transcriptase inhibitor, non-nucleoside reverse transcriptase inhibitor, PI, and integrase strand transfer inhibitor resistance were 72%, 82%, 10%, and 3%, respectively. Patients with PI resistance were more likely to respond to treatment with a non-tenofovir disoproxil fumarate/emtricitabine/efavirenz-based STR (.=0.004) and a longer duration of antiretroviral therapy (101 months [72.0-123.3] vs 11 months [7-44], =0.007). There were no associations between different STRs and transmission risk factors, HIV subtype, duration of antiretroviral therapy, and resistance to tenofovir disoproxil fumarate.
A high rate of antiretroviral drug resistance was found in the patients who failed STR treatment. The presence of PI resistance in these patients represented an inappropriate switch from a multiple tablet regimen to an STR. These findings should remind clinicians that detailed drug resistance history and close monitoring are mandatory after switching to an STR.
关于病毒学治疗失败的HIV-1感染患者对单片复方制剂（STR）耐药性流行情况的稀疏数据可用。本研究旨在评估台湾南部病毒学治疗失败的HIV-1感染患者中HIV基因型耐药性的流行情况。
这项回顾性研究调查了2016年1月至2017年9月期间病毒学治疗失败的STR患者的耐药性。使用2017年美国国际艾滋病学会HIV耐药性算法定义抗逆转录病毒耐药性突变，并使用斯坦福大学HIV耐药性数据库的HIVdb程序比较耐药性。比较耐药组和非耐药组之间的变量。
对39例HIV-1感染的治疗失败患者进行了耐药性检测，其中89%为男男性行为者感染。90%的患者中发现了B型HIV-1毒株。8例患者初治并开始使用STR，而31例患者在改用STR后出现治疗失败。87%的患者存在四类耐药中的任何一种（核苷类逆转录酶抑制剂、非核苷类逆转录酶抑制剂、蛋白酶抑制剂（PI）和整合酶链转移抑制剂）。核苷类逆转录酶抑制剂、非核苷类逆转录酶抑制剂、PI和整合酶链转移抑制剂耐药的发生率分别为72%、82%、10%和3%。PI耐药的患者更有可能对一种不含富马酸替诺福韦二吡呋酯/恩曲他滨/依非韦伦的STR治疗产生反应（.=0.004），且抗逆转录病毒治疗持续时间更长（101个月[72.0 - 123.3]对11个月[7 - 44]，=0.007）。不同的STR与传播风险因素、HIV亚型、抗逆转录病毒治疗持续时间以及对富马酸替诺福韦二吡呋酯的耐药性之间均无关联。
在STR治疗失败的患者中发现了较高的抗逆转录病毒药物耐药率。这些患者中PI耐药的存在表明从多片制剂方案不恰当地转换为STR。这些发现应提醒临床医生，在改用STR后，详细的耐药史和密切监测是必不可少的。
