美沙酮维持治疗的注射吸毒者中 HIV 耐药突变没有增加：一项前瞻性队列研究。

No Increase in HIV Drug Resistance Mutations among Injecting Drug Users on Methadone Maintenance Therapy: A Prospective Cohort Study.

机构信息

Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China

Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts 02118, USA

出版信息

Curr HIV Res. 2020;18(5):362-372. doi: 10.2174/1570162X18666200712173630.

DOI:10.2174/1570162X18666200712173630

PMID:32652910

Abstract

BACKGROUND

Whether HIV-positive injecting drug users (IDUs) are at higher risk of developing drug resistance mutations (DRMs) after methadone maintenance therapy (MMT) than any other HIV-positive population is unclear.

OBJECTIVE

To compare the incidence of new DRMs in two population groups: antiretroviraltreatment (ART) HIV-positive IDUs and non-drug users.

METHODS

A prospective cohort of ART HIV-positive patients including IDUs who received MMT (MMT group) and non-drug users (N-MMT group) was established from April 2016 to December 2017 in Guangxi, China.

RESULTS

Of the 80 participants, 43 were in the MMT group and 37 were in the N-MMT group. Compared with the N-MMT group, the HRs of PIs, NRTIs and NNRTIs for new DRMs in the MMT group was 1.55 (95%CI: 0.28-8.64; P = 0.616), 1.51 (95%CI: 0.44-5.20; P = 0.512) and 0.45 (95%CI: 0.15-1.35; P = 0.155), respectively. There was no dose-response relationship between MMT and new DRMs for PIs, NRTIs and NNRTIs (P > 0.05). The new DRM incidence for NRTIs (138.23 per 104 person-months) was higher than for PIs (94.16 per 104 person-months) and NNRTIs (95.41per 104 person-months) in the MMT group, while the new DRM incidence for NNRTIs (208.24 per 104 person-months) was higher than for PIs (44.13 per 104 person-months) and NRTIs (91.78 per 104 person-months) in the N-MMT group.

CONCLUSION

Among ART HIV-positive patients, there is no significant difference in the incidence of new DRMs between IDUs receiving MMT and non-drug users. MMT has little impact on the development of DRMs among IDUs.

摘要

背景

接受美沙酮维持治疗（MMT）的 HIV 阳性吸毒者（IDU）比任何其他 HIV 阳性人群发展耐药突变（DRMs）的风险更高，这一点尚不清楚。

目的

比较两组人群中新 DRM 的发生率：接受抗逆转录病毒治疗（ART）的 HIV 阳性 IDU 和非吸毒者。

方法

2016 年 4 月至 2017 年 12 月，在中国广西建立了包括接受 MMT 的 IDU（MMT 组）和非吸毒者（N-MMT 组）在内的接受 ART 的 HIV 阳性患者前瞻性队列。

结果

80 名参与者中，43 名在 MMT 组，37 名在 N-MMT 组。与 N-MMT 组相比，MMT 组中 PIs、NRTIs 和 NNRTIs 新发 DRM 的 HR 分别为 1.55（95%CI：0.28-8.64；P=0.616）、1.51（95%CI：0.44-5.20；P=0.512）和 0.45（95%CI：0.15-1.35；P=0.155）。MMT 与 PIs、NRTIs 和 NNRTIs 之间无剂量反应关系（P＞0.05）。在 MMT 组中，NRTIs 的新发 DRM 发生率（138.23 人年/104 人）高于 PIs（94.16 人年/104 人）和 NNRTIs（95.41 人年/104 人），而 N-MMT 组中 NNRTIs 的新发 DRM 发生率（208.24 人年/104 人）高于 PIs（44.13 人年/104 人）和 NRTIs（91.78 人年/104 人）。