Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania.
Medical Mission Institute, Wuerzburg, Germany.
J Antimicrob Chemother. 2018 Dec 1;73(12):3476-3481. doi: 10.1093/jac/dky332.
In a 2008-10 study, we found a pretreatment HIV drug resistance (PDR) prevalence of 18.2% in patients at Bugando Medical Centre (BMC) in Mwanza, Tanzania.
To determine the prevalence of PDR and transmitted HIV drug resistance (TDR) in patients visiting the BMC from 2013 to 2015.
Adult outpatients were sequentially enrolled into two groups, separated by whether they were initiating ART. Previous exposure to antiretroviral drugs, except for prevention of mother-to-child transmission, was an exclusion criterion. HIV pol sequences were analysed according to WHO guidelines for surveillance of PDR and TDR.
Two hundred and thirty-five sequences were analysed (138 ART initiators, 97 non-initiators). The prevalence of PDR was 4.7% (95% CI 2.6%-8.2%) overall, 3.1% (95% CI 1.1%-8.7%) for non-initiators and 5.8% (95% CI 3.0%-11.0%) for ART initiators. PDR to NNRTIs and nucleoside or nucelotide reverse transcriptase inhibitors was found in 3.0% (95% CI 1.5%-6.0%) and 1.7% (95% CI 0.7%-4.3%) of patients, respectively. Resistance to PIs was not observed. The prevalence of TDR was 6.0% (95% CI 3.6%-9.8%).
Prevalence of PDR significantly decreased compared with 2008-10 and was below the WHO-defined threshold for triggering a public health response. National and systematic surveillance is needed to inform Tanzania's public health strategy.
在 2008-10 年的一项研究中，我们发现坦桑尼亚姆万扎布加迪医疗中心（BMC）的患者中，治疗前 HIV 耐药（PDR）的患病率为 18.2%。
确定 2013 年至 2015 年期间到 BMC 就诊的患者中 PDR 和传播性 HIV 耐药（TDR）的流行率。
成年门诊患者分为两组，一组是正在开始接受抗逆转录病毒治疗（ART）的患者，另一组是未开始接受 ART 的患者。除了预防母婴传播之外，以前接触过抗逆转录病毒药物是排除标准。根据世界卫生组织（WHO）监测 PDR 和 TDR 的指南对 HIV pol 序列进行分析。
共分析了 235 个序列（138 个 ART 启动者，97 个非启动者）。总的 PDR 患病率为 4.7%（95%CI 2.6%-8.2%），非启动者为 3.1%（95%CI 1.1%-8.7%），ART 启动者为 5.8%（95%CI 3.0%-11.0%）。NNRTIs 和核苷或核苷酸逆转录酶抑制剂的耐药率分别为 3.0%（95%CI 1.5%-6.0%）和 1.7%（95%CI 0.7%-4.3%）。未观察到对蛋白酶抑制剂的耐药。TDR 的患病率为 6.0%（95%CI 3.6%-9.8%）。
与 2008-10 年相比，PDR 的患病率显著下降，且低于世界卫生组织（WHO）定义的触发公共卫生应对的阈值。需要进行国家和系统监测，以为坦桑尼亚的公共卫生策略提供信息。
