Laboratoire de Recherche en Épidémiologie de la Douleur Chronique, Université du Québec en Abitibi-Témiscamingue, Québec, Canada.
Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Québec, Canada.
AIDS Rev. 2020;22(2):78-92. doi: 10.24875/AIDSRev.20000012.
The continuous rising of HIV drug resistance in low- and middle-income countries and its impact on treatment failure is a growing threat for the HIV treatment response. This review aimed to document pre-antiretroviral therapy (ART) CD4 counts, emerging drug resistance, and treatment failure in HIV-infected individuals initiating ART. We performed an online search in PubMed, Embase, Web of Science, African Index Medicus, Cochrane library, and The National Institute for Health Clinical Trials Registry of relevant articles published from January 1996 to June 2019. Of 1755 original studies retrieved, 28 were retained for final analysis. Treatment failure varied between 5% (95% confidence interval [CI]: 2.7-7.4) and 72% (95% CI: 55-89.6), while resistance varied between 1% (95% CI: 0.47-1.5) and 48% (95% CI: 28.4-67.6). Participants with a pre-ART CD4 count below 200 cell/μl and low adherence showed higher percentages of resistance and failure, while those with CD4 count above 200 showed lower resistance and failure regardless adherence levels. Most frequent resistance mutations included the M184I/V for the nucleoside reverse-transcriptase inhibitors (NRTIs), K103N, and Y181 for the non-NRTIs (NNRTIs), and L90M for the Protease inhibitors. Pre-ART CD4 count and adherence to treatment could play a key role in reducing drug resistance and treatment failure. The increased access to ART in resources limited settings should be accompanied by regular CD4 count testing, drug resistance monitoring, and continuous promotion of adherence. In addition, the rising of resistance mutations associated with NRTIs and NNRTIs, suggest that alternative ART regimens should be considered. (AIDS Rev. 2020;22:
在中低收入国家，艾滋病毒耐药性的持续上升及其对治疗失败的影响，是艾滋病毒治疗应对工作面临的日益严重的威胁。本综述旨在记录开始抗逆转录病毒治疗（ART）前的 CD4 计数、新出现的耐药性以及开始 ART 的艾滋病毒感染者的治疗失败情况。我们在 PubMed、Embase、Web of Science、非洲医学索引、Cochrane 图书馆和美国国立卫生研究院临床试验注册中心进行了在线检索，检索了 1996 年 1 月至 2019 年 6 月期间发表的相关文章。在检索到的 1755 篇原始研究中，有 28 篇被保留用于最终分析。治疗失败率在 5%（95%置信区间[CI]：2.7-7.4）至 72%（95% CI：55-89.6）之间，而耐药率在 1%（95% CI：0.47-1.5）至 48%（95% CI：28.4-67.6）之间。在开始 ART 前 CD4 计数低于 200 个细胞/μl 和低依从性的患者中，耐药和失败的比例更高，而 CD4 计数高于 200 的患者无论依从性水平如何，耐药和失败的比例都较低。最常见的耐药突变包括核苷逆转录酶抑制剂（NRTIs）的 M184I/V、非核苷逆转录酶抑制剂（NNRTIs）的 K103N 和 Y181 以及蛋白酶抑制剂的 L90M。开始 ART 前的 CD4 计数和治疗依从性可能在降低耐药性和治疗失败方面发挥关键作用。在资源有限的环境中增加获得抗逆转录病毒治疗的机会，应同时进行定期的 CD4 计数检测、耐药性监测，并持续促进依从性。此外，与 NRTIs 和 NNRTIs 相关的耐药突变的增加表明，应考虑替代的抗逆转录病毒治疗方案。（AIDS Rev. 2020;22：
