安哥拉 HIV 遗传多样性和耐药突变的临床和公共卫生影响：系统评价。

Clinical and Public Health Implications of HIV- Genetic Diversity and Drug Resistance Mutations in Angola: A Systematic Review.

机构信息

Molecular Biology Laboratory, Instituto Nacional de Investigação em Saúde, Luanda, Angola; Centro de Investigação em Saúde de Angola, Luanda, Angola; Instituto Superior de Ciências da Saúde, Universidade Agostinho Neto, Luanda, Angola; Laboratory of Immunobiology and Pathogenesis of CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal.

Molecular Biology Laboratory, Instituto Nacional de Investigação em Saúde, Luanda, Angola; Centro de Investigação em Saúde de Angola, Luanda, Angola; Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola.

出版信息

AIDS Rev. 2020 Oct 26;23(1):48-56. doi: 10.24875/AIDSRev.20000057.

DOI:10.24875/AIDSRev.20000057

PMID:33105474

Abstract

HIV-1 genetic diversity and drug resistance mutations (DRMs) remain a public health concern mainly in low- and middle-income countries. In this review, we estimated the HIV-1 molecular evolution over the past 40 years (1980-2019) in Angola to help guide affordable strategies for HIV-1 epidemic surveillance. We searched for studies written in English or Portuguese on HIV-1 diversity and DRMs carried out in Angola and published between 1980 and 2019. This review yielded eight studies describing a total of 493 samples. No HIV-1 Group N, O, and P were identified, whereas a ll non-B subtypes f rom Group M were identified. About 66% of HIV-1 subtypes were pure subtype and 34% recombinant strains. The frequency of recombinant strains increases from 1980 to 2019 (23.6%-41.4%, p<0.001). The subtypes C, F1, CRF02_AG, and the recombinant U/H were the most frequent. One DRM in the PIs was found (I54 M), 22 in the nucleoside reverse transcriptase inhibitors (NRTIs), and 18 in the non-nucleoside reverse transcriptase inhibitors (NNRTIs). The major DRM in the NRTIs was the M184V, whereas the G190A, K103N, and Y181C were the major DRMs in the NNRTIs. Over the past 40 years, the frequency of the DRM M184V (50-64.3%, p=0.363), G190A (17.2-46.2%, p=0.021), and K103N (34.5-42.3%, p=0.551) increased, while the frequency of Y181C (17.2-7.7%, p=0.289) decreased. The current review shows an increase in HIV-1 genetic complexity and DRMs in Angola. Our findings suggest the need to include PIs or integrase strand transfer inhibitors in the first-line antiretroviral therapy regimens in Angola.

摘要

HIV-1 基因多样性和耐药突变（DRMs）仍然是一个主要的公共卫生问题，特别是在中低收入国家。在这篇综述中，我们估计了过去 40 年（1980-2019 年）安哥拉的 HIV-1 分子进化，以帮助指导 HIV-1 流行监测的负担得起的策略。我们搜索了 1980 年至 2019 年间在安哥拉用英文或葡萄牙文发表的关于 HIV-1 多样性和 DRMs 的研究。这项综述共包含 8 项研究，共描述了 493 个样本。没有发现 HIV-1 组 N、O 和 P，而 M 组的所有非 B 亚型都有发现。大约 66%的 HIV-1 亚型是纯亚型，34%是重组株。重组株的频率从 1980 年到 2019 年增加（23.6%-41.4%，p<0.001）。最常见的亚型是 C、F1、CRF02_AG 和 U/H 重组株。在蛋白酶抑制剂（PIs）中发现了一个耐药突变（I54M），在核苷逆转录酶抑制剂（NRTIs）中发现了 22 个，在非核苷逆转录酶抑制剂（NNRTIs）中发现了 18 个。NRTIs 中的主要耐药突变是 M184V，而 NNRTIs 中的主要耐药突变是 G190A、K103N 和 Y181C。在过去的 40 年里，耐药突变 M184V（50-64.3%，p=0.363）、G190A（17.2-46.2%，p=0.021）和 K103N（34.5-42.3%，p=0.551）的频率增加，而 Y181C（17.2-7.7%，p=0.289）的频率下降。目前的综述显示，安哥拉的 HIV-1 遗传复杂性和 DRMs 有所增加。我们的研究结果表明，安哥拉需要在一线抗逆转录病毒治疗方案中加入蛋白酶抑制剂或整合酶抑制剂。