Department of Infectious Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Infectious Diseases Hospital of Fuzhou, Fuzhou, Fujian, People's Republic of China.
Drug Des Devel Ther. 2021 Feb 26;15:889-894. doi: 10.2147/DDDT.S286863. eCollection 2021.
With the widespread use of integrase strand transfer inhibitors (INSTIs) in the clinical setting, transmission of INSTIs-resistance mutations may increase. Data regarding transmitted drug resistance mutations (TDRM) to INSTIs in Chinese HIV patients are limited. The aim of this study was to summarize the INSTIs TDRM, including the frequency of protease inhibitors (PIs) and reverse transcriptase (RT) inhibitors (RTIs) mutations in treatment-naïve patients in Southeast China.
HIV-1 positive patients were retrospectively selected between April 2018 and October 2020 from the Mengchao Hepatobiliary Hospital of Fujian Medical University, the largest designated HIV/AIDS care hospital in Southeast China. Individuals who were antiretroviral therapy-naïve and received antiretroviral drug resistance testing at baseline were included. Clinical data including demographic data, CD4 counts, HIV-RNA loads, and drug resistance mutations were collected.
A total of 147 patients were enrolled. INSTIs TDRM was rare, with only one primary integrase mutation E138K observed in one sample and one secondary mutation E157Q detected in another sample. The overall prevalence of INSTIs TDRM was 1.36%. A substantial proportion of patients harbored common INSTIs-associated polymorphic variants. Two samples harbored the T215S, M184V and K70E mutations related to nucleoside RTIs (NRTIs). Twelve patients carried nonnucleoside RTIs (NNRTIs)-resistance mutations. Two individuals harbored PIs-resistance mutations: Q58E in one patient and M46I, I54V, V82A, L10F, and Q58E mutations in another patient. The total TDRM rate for RTIs and PIs was 10.20% (15/147), but only 0.68% (1/147) was according to the WHO recommendations on TDRM.
The rate of INSTIs TDRM was low among therapy-naïve HIV patients in Southeast China. INSTIs as a first-line regimen are suitable for untreated HIV-1 patients in Southeast China. But special attention must be still paid to INSTIs TDRM in clinical practice.
随着整合酶抑制剂（INSTIs）在临床中的广泛应用，INSTIs 耐药突变的传播可能会增加。关于中国 HIV 患者对 INSTIs 耐药突变（TDRM）的相关数据有限。本研究的目的是总结 INSTIs TDRM，包括在中国东南地区初治患者中蛋白酶抑制剂（PIs）和逆转录酶抑制剂（RTIs）突变的频率。
本研究回顾性选择了 2018 年 4 月至 2020 年 10 月期间来自福建医科大学孟超肝胆医院的 HIV-1 阳性患者，该医院是中国东南地区最大的指定 HIV/AIDS 护理医院。本研究纳入了初治且基线时接受抗逆转录病毒药物耐药性检测的患者。收集了包括人口统计学数据、CD4 计数、HIV-RNA 载量和耐药突变在内的临床数据。
共纳入 147 例患者。INSTIs TDRM 罕见，仅在 1 个样本中发现 1 个主要整合酶突变 E138K，在另 1 个样本中发现 1 个次要突变 E157Q。总的 INSTIs TDRM 发生率为 1.36%。相当一部分患者携带常见的 INSTIs 相关多态性变异。2 个样本携带与核苷类逆转录酶抑制剂（NRTIs）相关的 T215S、M184V 和 K70E 突变。12 例患者携带非核苷类逆转录酶抑制剂（NNRTIs）耐药突变。2 例患者携带蛋白酶抑制剂（PI）耐药突变：1 例患者 Q58E，另 1 例患者 M46I、I54V、V82A、L10F 和 Q58E 突变。RTIs 和 PIs 的总 TDRM 率为 10.20%（15/147），但仅 0.68%（1/147）符合世卫组织关于 TDRM 的建议。
在中国东南地区初治 HIV 患者中，INSTIs TDRM 率较低。INSTIs 作为一线治疗方案适合中国东南地区未经治疗的 HIV-1 患者。但在临床实践中仍需特别注意 INSTIs TDRM。
