Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
J Antimicrob Chemother. 2019 Jul 1;74(7):2024-2029. doi: 10.1093/jac/dkz134.
The aim of this study was to assess the prevalence of HIV drug resistance (HIVDR) in HIV-infected ART-naive and -experienced patients in Sierra Leone.
We conducted a cross-sectional study of HIV-positive adults aged ≥18 years at Connaught Hospital in Freetown, Sierra Leone in November 2017. Sequencing was performed in the reverse transcriptase, protease and integrase regions, and interpreted using the Stanford HIVDR database and WHO 2009 mutation list.
Two hundred and fifteen HIV-infected patients were included (64 ART naive and 151 ART experienced). The majority (66%) were female, the median age was 36 years and the median ART exposure was 48 months. The majority (83%) were infected with HIV-1 subtype CRF02_AG. In the ART-naive group, the pretreatment drug resistance (PDR) prevalence was 36.7% (14.2% to NRTIs and 22.4% to NNRTIs). The most prevalent PDR mutations were K103N (14.3%), M184V (8.2%) and Y181C (4.1%). In the ART-experienced group, 64.4% harboured resistance-associated mutations (RAMs) and the overall prevalence of RAMs to NRTIs and NNRTIs was 85.2% (52/61) and 96.7% (59/61), respectively. The most prevalent RAMs were K103N (40.7%), M184V (28.8%), D67N (15.3%) and T215I/F/Y (15.3%). Based on the genotypic susceptibility score estimates, 22.4% of ART-naive patients and 56% of ART-experienced patients were not susceptible to first-line ART used in Sierra Leone.
A high prevalence of circulating NRTI- and NNRTI-resistant variants was observed in ART-naive and -experienced HIV-1-infected patients in Sierra Leone. This necessitates the implementation of HIVDR surveillance programmes to inform national ART guidelines for the treatment and monitoring of HIV-infected patients in Sierra Leone.
本研究旨在评估塞拉利昂未经治疗和经治的 HIV 感染患者中 HIV 耐药（HIVDR）的流行率。
我们于 2017 年 11 月在塞拉利昂弗里敦的康诺特医院对年龄≥18 岁的 HIV 阳性成年人进行了一项横断面研究。在逆转录酶、蛋白酶和整合酶区域进行测序，并使用斯坦福 HIVDR 数据库和世卫组织 2009 年突变列表进行解释。
共纳入 215 例 HIV 感染患者（64 例为初治，151 例为经治）。大多数（66%）为女性，中位年龄为 36 岁，中位 ART 暴露时间为 48 个月。大多数（83%）感染 HIV-1 亚型 CRF02_AG。在初治组中，治疗前耐药（PDR）的流行率为 36.7%（NRTIs 为 14.2%，NNRTIs 为 22.4%）。最常见的 PDR 突变是 K103N（14.3%）、M184V（8.2%）和 Y181C（4.1%）。在经治组中，64.4%携带耐药相关突变（RAMs），NRTIs 和 NNRTIs 的 RAM 总流行率分别为 85.2%（52/61）和 96.7%（59/61）。最常见的 RAMs 是 K103N（40.7%）、M184V（28.8%）、D67N（15.3%）和 T215I/F/Y（15.3%）。基于基因型药敏评分估计，22.4%的初治患者和 56%的经治患者对塞拉利昂使用的一线抗逆转录病毒药物不敏感。
在塞拉利昂未经治疗和经治的 HIV-1 感染患者中，观察到循环 NRTI 和 NNRTI 耐药变异的高流行率。这需要实施 HIVDR 监测计划，为塞拉利昂 HIV 感染患者的治疗和监测提供国家 ART 指南。
