Thanprasertsuk Sombat, Phokhasawad Kunjanakorn, Teeraratkul Achara, Chasombat Sanchai, Pattarapayoon Naparat, Saeng-Aroon Siriphan, Yuktanon Porntip, Kohreanudom Surapol, Lertpiriyasuwat Cheewanan
Department of Disease Control, Ministry of Public Health, Thailand.
Thailand MOPH-US CDC collaboration, Division of Global HIV and Tuberculosis, Thailand.
Outbreak Surveill Investig Rep. 2018;11(1):6-13.
In Thailand, antiretroviral therapy (ART) was initiated to treat human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) cases using the empirical regimen with no prior genotypic test to determine drug resistance. In order to assess prevalence rate of HIV drug resistance (HIVDR) among pre-treatment cases, four rounds of survey were carried out in ART clinics, including six, eight, 33 and four ART clinics in each round during 2006-2013. For which, HIVDR testing results were available in 310, 350, 797, and 413 cases in four rounds. It was revealed that HIVDR rates among naive cases were 2.0%, 2.8%, 4.0% and 4.8%, while in experienced cases, the rates were 0, 3.3%, 11.4% and 13.9%. The rates among all cases were 1.9%, 2.9%, 4.4% and 5.6%. Resistant drugs with the highest rates among all cases in the survey round 4 were nevirapine (3.6%) and efavirenz (3.1%). The results indicated the need to continue surveillance for pre-treatment HIVDR, and posed challenges to implement activities for protecting efficacy and prolong the use of empirical first-line regimen. A strategy to apply genotyping test, in a cost-effective approach, should be considered to prepare for situation when HIVDR increases beyond a critical level.
在泰国，抗逆转录病毒疗法（ART）被用于治疗人类免疫缺陷病毒感染及获得性免疫缺陷综合征（HIV/AIDS）病例，采用的是经验性治疗方案，未事先进行基因型检测以确定耐药性。为评估治疗前病例中HIV耐药性（HIVDR）的流行率，在抗逆转录病毒治疗诊所开展了四轮调查，2006 - 2013年期间每轮分别涉及6家、8家、33家和4家抗逆转录病毒治疗诊所。四轮调查中分别有310例、350例、797例和413例可获得HIVDR检测结果。结果显示，初治病例中的HIVDR率分别为2.0%、2.8%、4.0%和4.8%，而复治病例中的率分别为0、3.3%、11.4%和13.9%。所有病例中的率分别为1.9%、2.9%、4.4%和5.6%。在第四轮调查的所有病例中，耐药率最高的药物是奈韦拉平（3.6%）和依非韦伦（3.1%）。结果表明需要继续监测治疗前的HIVDR情况，并对实施保护疗效及延长经验性一线治疗方案使用时间的活动构成了挑战。应考虑采用一种具有成本效益的方法应用基因分型检测策略，为HIVDR上升至临界水平以上的情况做好准备。
