抗逆转录病毒药物的使用和艾滋病毒耐药性在坦桑尼亚和多米尼加共和国的性工作者。
Antiretroviral drug use and HIV drug resistance in female sex workers in Tanzania and the Dominican Republic.
机构信息
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland, United States of America.
出版信息
PLoS One. 2020 Oct 29;15(10):e0240890. doi: 10.1371/journal.pone.0240890. eCollection 2020.
OBJECTIVE
Female sex workers (FSW) have increased risk of HIV infection. Antiretroviral treatment (ART) can improve HIV outcomes and prevent HIV transmission. We analyzed antiretroviral (ARV) drug use and HIV drug resistance among HIV-positive FSW in the Dominican Republic and Tanzania.
METHODS
Plasma samples collected at study entry with viral loads >1,000 copies/mL were tested for ARV drugs and HIV drug resistance. ARV drug testing was performed using a qualitative assay that detects 22 ARV drugs in five classes. HIV genotyping was performed using the ViroSeq HIV-1 Genotyping System. Phylogenetic analyses were performed to determine HIV subtype and assess transmission clusters.
RESULTS
Among 410 FSW, 144 (35.1%) had viral loads >1,000 copies/mL (DR: n = 50; Tanzania: n = 94). ARV drugs were detected in 36 (25.0%) of 144 samples. HIV genotyping results were obtained for 138 (95.8%) cases. No transmission clusters were observed in either country. HIV drug resistance was detected in 54 (39.1%) of 138 samples (31/35 [88.6%] with drugs detected; 23/103 [22.3%] without drugs detected); 29/138 (21.0%) had multi-class resistance (MCR). None with MCR had integrase strand transfer inhibitor resistance. In eight cases, one or more ARV drug was detected without corresponding resistance mutations; those women were at risk of acquiring additional drug resistance. Using multivariate logistic regression, resistance was associated with ARV drug detection (p<0.001), self-reported ART (full adherence [p = 0.034]; partial adherence [p<0.001]), and duration of HIV infection (p = 0.013).
CONCLUSIONS
In this cohort, many women were on ART, but were not virally suppressed. High levels of HIV drug resistance, including MCR, were observed. Resistance was associated with detection of ARV drugs, self-report of ART with full or partial adherence, and duration of HIV infection. These findings highlight the need for better HIV care among FSW to improve their health, reduce HIV drug resistance, and decrease risk of transmission to others.
目的
性工作者（FSW）感染 HIV 的风险增加。抗逆转录病毒治疗（ART）可以改善 HIV 结局并预防 HIV 传播。我们分析了多米尼加共和国和坦桑尼亚 HIV 阳性 FSW 中抗逆转录病毒（ARV）药物的使用情况和 HIV 耐药性。
方法
采集研究开始时病毒载量>1000 拷贝/ml 的血浆样本，检测 ARV 药物和 HIV 耐药性。ARV 药物检测使用定性检测，可检测五类 22 种 ARV 药物。采用 ViroSeq HIV-1 基因分型系统进行 HIV 基因分型。进行系统进化分析以确定 HIV 亚型并评估传播簇。
结果
在 410 名 FSW 中，有 144 名（35.1%）病毒载量>1000 拷贝/ml（DR：n=50；坦桑尼亚：n=94）。在 144 个样本中检测到 36 个（25.0%）ARV 药物。对 138 例（95.8%）病例获得了 HIV 基因分型结果。在两个国家均未观察到传播簇。在 54 个（39.1%）样本中检测到 HIV 耐药性（35 个中检测到药物耐药性[88.6%]；103 个中未检测到药物耐药性[22.3%]）；29 个（21.0%）有多种耐药性（MCR）。无 MCR 的患者没有整合酶链转移抑制剂耐药性。在 8 例中，检测到一种或多种 ARV 药物，但没有相应的耐药突变；这些女性有获得额外耐药性的风险。多变量逻辑回归分析显示，耐药性与 ARV 药物检测（p<0.001）、自我报告的 ART（完全依从性[p=0.034]；部分依从性[p<0.001]）和 HIV 感染持续时间（p=0.013）相关。
结论
在该队列中，许多女性正在接受 ART，但并未病毒抑制。观察到高水平的 HIV 耐药性，包括 MCR。耐药性与 ARV 药物检测、自我报告的 ART （完全或部分依从）以及 HIV 感染持续时间有关。这些发现强调了需要更好地为 FSW 提供 HIV 护理，以改善他们的健康状况，减少 HIV 耐药性，并降低向他人传播的风险。
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