Department of Prevention, Care and Treatment, Institute of Human Virology-Nigeria (IHVN), Federal Capital Territory, Plot 252, Herbert Macaulay Way, Central Business District, Abuja, Nigeria.
Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
AIDS Res Ther. 2020 Feb 17;17(1):7. doi: 10.1186/s12981-020-0261-z.
Expanded access to combination antiretroviral therapy (cART) throughout sub-Saharan Africa over the last decade has remarkably improved the prognosis of persons living with HIV (PLWH). However, some PLWH experience virologic rebound after a period of viral suppression, usually followed by selection of drug resistant virus. Determining factors associated with drug resistance can inform patient management and healthcare policies, particularly in resource-limited settings where drug resistance testing is not routine.
A case-control study was conducted using data captured from an electronic medical record in a large treatment program in Nigeria. Cases PLWH receiving cART who developed acquired drug resistance (ADR) and controls were those without ADR between 2004 and 2011. Each case was matched to up to 2 controls by sex, age, and education. Logistic regression was used estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with ADR.
We evaluated 159 cases with ADR and 299 controls without ADR. In a multivariate model, factors associated with ADR included older age (OR = 2.35 [age 30-40 years 95% CI 1.29, 4.27], age 41 + years OR = 2.31 [95% CI 1.11, 4.84], compared to age 17-30), higher education level (secondary OR 2.14 [95% CI 1.1.11-4.13]), compared to primary and tertiary), non-adherence to care (OR = 2.48 [95% CI 1.50-4.00]), longer treatment duration (OR = 1.80 [95% CI 1.37-2.35]), lower CD4 count((OR = 0.95 [95% CI 0.95-0.97]) and higher viral load (OR = 1.97 [95% CI 1.44-2.54]).
Understanding these predictors may guide programs in developing interventions to identify patients at risk of developing ADR and implementing prevention strategies.
过去十年，撒哈拉以南非洲地区扩大了联合抗逆转录病毒疗法（cART）的获取途径，极大地改善了艾滋病毒感染者（PLWH）的预后。然而，一些 PLWH 在病毒抑制一段时间后会出现病毒学反弹，通常随后会选择耐药病毒。确定与耐药性相关的因素可以为患者管理和医疗保健政策提供信息，特别是在资源有限的环境中，耐药性检测不是常规进行的。
这项研究使用了尼日利亚一个大型治疗项目的电子病历中捕获的数据，开展了一项病例对照研究。病例是在 2004 年至 2011 年间接受 cART 治疗且发生获得性耐药（ADR）的 PLWH，对照组是未发生 ADR 的患者。每个病例通过性别、年龄和教育程度与最多 2 名对照相匹配。使用逻辑回归来估计与 ADR 相关的因素的比值比（OR）和 95%置信区间（CI）。
我们评估了 159 例 ADR 病例和 299 例无 ADR 对照。在多变量模型中，与 ADR 相关的因素包括年龄较大（30-40 岁年龄组 OR=2.35[95%CI 1.29,4.27]，41 岁及以上年龄组 OR=2.31[95%CI 1.11,4.84]，与 17-30 岁年龄组相比）、较高的教育水平（中学 OR=2.14[95%CI 1.11-4.13]，与小学和高等教育相比）、不遵医嘱（OR=2.48[95%CI 1.50-4.00]）、治疗时间较长（OR=1.80[95%CI 1.37-2.35]）、CD4 计数较低（OR=0.95[95%CI 0.95-0.97]）和病毒载量较高（OR=1.97[95%CI 1.44-2.54]）。
了解这些预测因素可能有助于项目制定干预措施，以识别有发生 ADR 风险的患者，并实施预防策略。
