尼日利亚男同性恋者和感染艾滋病毒的变性女性中传播的、治疗前和获得性抗逆转录病毒药物耐药性情况。

Transmitted, pre-treatment and acquired antiretroviral drug resistance among men who have sex with men and transgender women living with HIV in Nigeria.

作者信息

Crowell Trevor A, Kijak Gustavo H, Sanders-Buell Eric, O'Sullivan Anne Marie, Kokogho Afoke, Parker Zahra F, Lawlor John, Polyak Christina S, Adebajo Sylvia, Nowak Rebecca G, Baral Stefan D, Robb Merlin L, Charurat Manhattan E, Ake Julie A, Ndembi Nicaise, Tovanabutra Sodsai

机构信息

US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.

Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.

出版信息

Antivir Ther. 2019;24(8):595-601. doi: 10.3851/IMP3342.

DOI:10.3851/IMP3342

PMID:32125280

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7304299/

Abstract

BACKGROUND

Across sub-Saharan Africa, men who have sex with men (MSM) and transgender women (TGW) have disproportionately poor HIV treatment outcomes. Stigma and criminalization create barriers to health-care engagement and adherence to antiretroviral therapy (ART), potentially promoting the development of HIV drug resistance (HIVDR). We evaluated transmitted, pre-treatment and acquired HIVDR among MSM and TGW in Lagos and Abuja, Nigeria.

METHODS

Adults with HIV RNA ≥1,000 copies/ml in the TRUST/RV368 cohort, including incident cases diagnosed via 3-monthly screening, underwent HIVDR testing using the Sanger sequencing method. Major mutations conferring resistance to nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were identified from the 2017 IAS-USA list. World Health Organization surveillance drug resistance mutations (SDRMs) were identified in ART-naive participants.

RESULTS

From March 2013 to June 2017, 415 participants with median age 24 (interquartile range [IQR] 21-27) years, CD4 T-cell count 370 (IQR 272-502) cells/mm, and HIV RNA 4.73 (IQR 4.26-5.15) log copies/ml underwent HIVDR testing. SDRMs were observed in 36 of 373 ART-naive participants (9.7%, 95% confidence interval [95% CI 6.8, 13.1%]), including 8 of 39 incident cases (20.5%, [95% CI] 9.3, 36.5%). Among 42 ART-experienced participants, NNRTI resistance was detected in 18 (42.9%, 95% CI 27.7, 59.0%) and NRTI resistance in 10 (23.8%, 95% CI 12.0, 39.4%). No PI resistance was detected.

CONCLUSIONS

The high prevalence of transmitted and acquired drug resistance among Nigerian MSM and TGW living with HIV suggests the need for programmatic solutions to improve uninterrupted access to ART and timely switch to second-line regimens in cases of viral failure.

摘要

背景

在撒哈拉以南非洲地区，男男性行为者（MSM）和变性女性（TGW）的艾滋病毒治疗效果格外差。耻辱感和刑事定罪给医疗保健参与及抗逆转录病毒疗法（ART）的依从性造成障碍，可能促使艾滋病毒耐药性（HIVDR）的发展。我们评估了尼日利亚拉各斯和阿布贾的男男性行为者和变性女性中传播性、治疗前和获得性艾滋病毒耐药性情况。

方法

在TRUST/RV368队列中，HIV RNA≥1000拷贝/ml的成年人，包括通过每3个月筛查确诊的新发病例，采用桑格测序法进行艾滋病毒耐药性检测。从2017年美国国际艾滋病学会（IAS-USA）列表中确定对核苷类逆转录酶抑制剂（NRTIs）、非核苷类逆转录酶抑制剂（NNRTIs）和蛋白酶抑制剂（PIs）具有耐药性的主要突变。在未接受过抗逆转录病毒治疗的参与者中确定世界卫生组织监测的耐药性突变（SDRMs）。

结果

从2013年3月至2017年6月，415名参与者接受了艾滋病毒耐药性检测，他们的年龄中位数为24岁（四分位间距[IQR]为21 - 27岁），CD4 T细胞计数为370（IQR为272 - 502）个细胞/mm，HIV RNA为4.73（IQR为4.26 - 5.15）log拷贝/ml。在373名未接受过抗逆转录病毒治疗的参与者中，有36人（9.7%，95%置信区间[95%CI]为6.8，13.1%）检测到SDRMs，其中39名新发病例中有8人（20.5%，[95%CI]为9.3，36.5%）。在42名有抗逆转录病毒治疗经验的参与者中，18人（42.9%，95%CI为27.7，59.0%）检测到对NNRTIs耐药，10人（23.8%，95%CI为12.0，39.4%）检测到对NRTIs耐药。未检测到对PIs耐药。