Universidad del Valle de Guatemala, Guatemala City, Guatemala.
Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico.
J Int AIDS Soc. 2019 Dec;22(12):e25429. doi: 10.1002/jia2.25429.
A nationally representative HIV drug resistance (HIVDR) survey in Nicaragua was conducted to estimate the prevalence of pretreatment HIVDR (PDR) among antiretroviral therapy (ART) initiators and acquired HIVDR among people living with HIV (PLHIV) who had received ART for 12 ± 3 months (ADR12) and ≥48 months (ADR48).
A nationwide cross-sectional survey with a two-stage cluster sampling was conducted from March to November 2016. Nineteen of 45 total ART clinics representing >90% of the national cohort of adults on ART were included. ART initiators were defined as PLHIV initiating or reinitiating first-line ART. HIVDR was assessed for protease, reverse transcriptase and integrase Sanger sequences using the Stanford HIVdb algorithm. Viral load (VL) suppression was defined as <1000 copies/mL. Results were weighted according to the survey design.
A total of 638 participants were enrolled (PDR: 171; ADR12: 114; ADR48: 353). The proportion of ART initiators with prior exposure to antiretrovirals (ARVs) was 12.3% (95% CI: 5.8% to 24.3%). PDR prevalence to any drug was 23.4% (95% CI: 14.4% to 35.6%), and 19.3% (95% CI: 12.2% to 29.1%) to non-nucleoside reverse transcriptase inhibitors (NNRTI). NNRTI PDR was higher in ART initiators with previous ARV exposure compared with those with no exposure (76.2% vs. 11.0%, p < 0.001). Protease inhibitors (PI) and integrase strand transfer inhibitors PDR was not observed. VL suppression rate was 77.8% (95% CI: 67.1% to 85.8%) in ADR12 and 70.3% (95% CI: 66.7% to 73.8%) in ADR48. ADR12 prevalence to any drug among PLHIV without VL suppression was 85.1% (95% CI: 66.1% to 94.4%), 82.4% to NNRTI and 70.2% to nucleoside reverse transcriptase inhibitors (NRTI). ADR48 prevalence to any drug among PLHIV without VL suppression was 75.5% (95% CI: 63.5% to 84.5 %), 70.7% to NNRTI, 59.4% to NRTI and 4.6% to PI.
Despite implementation challenges yielding low-precision HIVDR estimates, high rates of NNRTI PDR were observed in Nicaragua, suggesting consideration of non-NNRTI-based first-line regimens for ART initiators. Strengthened HIVDR monitoring, systematic VL testing, and improved ART adherence support are also warranted.
在尼加拉瓜进行了一项全国性的 HIV 耐药性（HIVDR）调查，以估计接受抗逆转录病毒治疗（ART）的新启动者中治疗前 HIVDR（PDR）的流行率以及接受 ART 治疗 12±3 个月（ADR12）和≥48 个月（ADR48）的 HIV 感染者中获得的 HIVDR。
2016 年 3 月至 11 月进行了一项全国性的横断面调查，采用两阶段聚类抽样。共纳入了 45 家 ART 诊所中的 19 家，这些诊所代表了全国成年 ART 队列中 >90%的人群。ART 新启动者定义为首次开始或重新开始一线 ART 的 HIV 感染者。使用斯坦福 HIVdb 算法对蛋白酶、逆转录酶和整合酶 Sanger 序列进行 HIVDR 评估。病毒载量（VL）抑制定义为 <1000 拷贝/ml。结果根据调查设计进行加权。
共纳入了 638 名参与者（PDR：171 名；ADR12：114 名；ADR48：353 名）。有先前接触过抗逆转录病毒药物（ARV）的 ART 新启动者比例为 12.3%（95%CI：5.8%至 24.3%）。任何药物的 PDR 流行率为 23.4%（95%CI：14.4%至 35.6%），而对非核苷类逆转录酶抑制剂（NNRTI）的 PDR 为 19.3%（95%CI：12.2%至 29.1%）。与无 ARV 暴露者相比，有先前 ARV 暴露的 ART 新启动者中 NNRTI PDR 更高（76.2% vs. 11.0%，p<0.001）。未观察到蛋白酶抑制剂（PI）和整合酶链转移抑制剂的 PDR。ADR12 时 VL 抑制率为 77.8%（95%CI：67.1%至 85.8%），ADR48 时为 70.3%（95%CI：66.7%至 73.8%）。VL 未抑制的 HIV 感染者中，ADR12 时任何药物的 ADR 流行率为 85.1%（95%CI：66.1%至 94.4%），NNRTI 为 82.4%，NRTI 为 70.2%。VL 未抑制的 HIV 感染者中，ADR48 时任何药物的 ADR 流行率为 75.5%（95%CI：63.5%至 84.5%），NNRTI 为 70.7%，NRTI 为 59.4%，PI 为 4.6%。
尽管实施方面的挑战导致 HIVDR 估计精度较低，但尼加拉瓜仍观察到很高的 NNRTI PDR 率，这表明需要考虑基于非 NNRTI 的一线治疗方案。还需要加强 HIVDR 监测、系统的 VL 检测和改善 ART 依从性支持。
