中国广东地区接受过 ART 治疗的患者中 HIV-1 CRF55_01B 的耐药特征。

Characteristics of drug resistance in HIV-1 CRF55_01B from ART-experienced patients in Guangdong, China.

机构信息

Infectious Disease Institute of Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.

Institute of AIDS/STD Prevention and Control, Beijing Center for Disease Prevention and Control, Beijing, China.

出版信息

J Antimicrob Chemother. 2020 Jul 1;75(7):1925-1931. doi: 10.1093/jac/dkaa116.

DOI:10.1093/jac/dkaa116

PMID:32300784

Abstract

BACKGROUND

HIV-1 acquired drug resistance (ADR) has become a critical clinical and public health issue. Recently, HIV-1 CRF55_01B has been found more frequently in the MSM population.

OBJECTIVE

To investigate the characteristics of HIV-1 drug resistance mutations (DRMs) and the extent of changes in drug susceptibility among ART-experienced CRF55_01B-infected adults of Guangdong.

METHODS

ADR was tested for immediately in CRF55_01B-infected patients with virological failure. Demographic and epidemiological information was collected. DRMs and antiretroviral susceptibility were interpreted using the Stanford University HIV Drug Resistance Database HIVdb program.

RESULTS

Overall, 162 (4.78%) CRF55_01B isolates were identified from 2013 to 2018. Among DRMs, M184V (43.83%) was the most frequent NRTI DRM, followed by K65R (23.46%), and V179E (98.77%) was the most frequent NNRTI DRM, followed by K103N (47.53%) and Y181C (14.81%). According to the HIVdb program, 79.01% of the CRF55_01B-infected patients carried mutations conferring low-level or higher drug resistance to any of the three classes of ART drugs. Among PI DRMs, only one mutation affording low-level resistance to nelfinavir was found (0.62%). Among NRTI DRMs, a high proportion of high-level resistance to lamivudine (58.64%) and emtricitabine (58.02%) was found. As regards NNRTIs, more than 75% of patients carried efavirenz and nevirapine DRMs. The percentages of high-level resistance were 70.99%, 63.58%, 22.22%, 17.90% and 4.32% for nevirapine, efavirenz, rilpivirine, doravirine and etravirine, respectively.

CONCLUSIONS

High frequencies of DRMs and resistance were observed among CRF55_01B-infected patients failing ART in Guangdong, and interventions may be considered to minimize ecological contributions to ART.

摘要

背景

HIV-1 获得性耐药（ADR）已成为一个重要的临床和公共卫生问题。最近，在男男性行为者（MSM）人群中发现 HIV-1 CRF55_01B 更为常见。

目的

调查广东地区经 ART 治疗的 CRF55_01B 感染成人中 HIV-1 耐药突变（DRMs）的特征以及药物敏感性变化程度。

方法

对发生病毒学失败的 CRF55_01B 感染患者进行即时 ADR 检测。收集人口统计学和流行病学信息。使用斯坦福大学 HIV 耐药数据库（HIVdb）程序解释 DRMs 和抗逆转录病毒药物敏感性。

结果

2013 年至 2018 年期间，共发现 162 例（4.78%）CRF55_01B 分离株。在 DRMs 中，最常见的 NRTI 耐药突变是 M184V（43.83%），其次是 K65R（23.46%），最常见的 NNRTI 耐药突变是 V179E（98.77%），其次是 K103N（47.53%）和 Y181C（14.81%）。根据 HIVdb 程序，79.01%的 CRF55_01B 感染患者携带对三种 ART 药物中的任何一种均具有低水平或高水平耐药性的突变。在 PI DRMs 中，仅发现一种对奈韦拉平具有低水平耐药性的突变（0.62%）。在 NRTI DRMs 中，发现拉米夫定（58.64%）和恩曲他滨（58.02%）高水平耐药的比例较高。至于 NNRTIs，超过 75%的患者携带依非韦伦和奈韦拉平耐药突变。高水平耐药的比例分别为奈韦拉平 70.99%、依非韦伦 63.58%、rilpivirine 22.22%、doravirine 17.90%和 etravirine 4.32%。