Puerta de Hierro University Hospital and Research Institute, Madrid, Spain.
Hospital de Poniente, Almeria, Spain.
J Antimicrob Chemother. 2019 May 1;74(5):1357-1362. doi: 10.1093/jac/dkz007.
HIV-2 is a neglected virus despite estimates of 1-2 million people being infected worldwide. The virus is naturally resistant to some antiretrovirals used to treat HIV-1 and therapeutic options are limited for patients with HIV-2.
In this retrospective observational study, we analysed all HIV-2-infected individuals treated with integrase strand transfer inhibitors (INSTIs) recorded in the Spanish HIV-2 cohort. Demographics, treatment modalities, laboratory values, quantitative HIV-2 RNA and CD4 counts as well as drug resistance were analysed.
From a total of 354 HIV-2-infected patients recruited by the Spanish HIV-2 cohort as of December 2017, INSTIs had been given to 44, in 18 as first-line therapy and in 26 after failing other antiretroviral regimens. After a median follow-up of 13 months of INSTI-based therapy, undetectable viraemia for HIV-2 was achieved in 89% of treatment-naive and in 65.4% of treatment-experienced patients. In parallel, CD4 gains were 82 and 126 cells/mm3, respectively. Treatment failure occurred in 15 patients, 2 being treatment-naive and 13 treatment-experienced. INSTI resistance changes were recognized in 12 patients: N155H (5), Q148H/R (3), Y143C/G (3) and R263K (1).
Combinations based on INSTIs are effective and safe treatment options for HIV-2-infected individuals. However, resistance mutations to INSTIs are selected frequently in failing patients, reducing the already limited treatment options.
尽管全球估计有 100 万至 200 万人感染了 HIV-2，但该病毒仍被忽视。该病毒天然对一些用于治疗 HIV-1 的抗逆转录病毒药物具有耐药性，而 HIV-2 患者的治疗选择有限。
在这项回顾性观察性研究中，我们分析了西班牙 HIV-2 队列中记录的所有接受整合酶链转移抑制剂（INSTIs）治疗的 HIV-2 感染者。分析了人口统计学、治疗方式、实验室值、定量 HIV-2 RNA 和 CD4 计数以及耐药性。
截至 2017 年 12 月，西班牙 HIV-2 队列共招募了 354 名 HIV-2 感染者，其中 44 名接受了 INSTIs 治疗，18 名作为一线治疗，26 名在其他抗逆转录病毒方案失败后接受了治疗。在基于 INSTI 的治疗中位随访 13 个月后，治疗初治患者中 89%和治疗经验患者中 65.4%的患者达到了 HIV-2 病毒血症不可检测。同时，CD4 分别增加了 82 和 126 个细胞/mm3。15 名患者发生治疗失败，其中 2 名治疗初治患者，13 名治疗经验患者。在 12 名患者中发现了 INSTI 耐药性变化：N155H（5）、Q148H/R（3）、Y143C/G（3）和 R263K（1）。
基于 INSTIs 的联合治疗是 HIV-2 感染者有效且安全的治疗选择。然而，在失败的患者中经常会选择对 INSTIs 的耐药突变，从而减少了已经有限的治疗选择。
