Model Development Section, Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD, USA.
Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Antimicrob Chemother. 2021 Dec 24;77(1):185-195. doi: 10.1093/jac/dkab361.
Integrase strand transfer inhibitor (InSTI)-based regimens have become the major first-line treatment for HIV-1-infected patients in Taiwan. Transmitted drug resistance (TDR) and several clinical characteristics are associated with time to virological failure or viral suppression; however, these have not been investigated in Taiwan.
To determine the impact of several factors on treatment outcomes in HIV-1-infected patients in Taiwan.
The cohort included 164 HIV-1 treatment-naive patients in Taiwan from 2018 to 2020. Blood specimens were collected to determine the genotypic drug resistance using the Stanford University HIV drug resistance database. Cox proportional hazards models were used to identify factors associated with time to virological failure or viral suppression.
The prevalence of TDR in Taiwan was 27.4% and an increasing trend was seen from 2018 to 2020. TDR mutations related to NNRTIs were the most prevalent (21%) while TDR to InSTIs remained at a relatively low level (1.3%). A baseline HIV-1 viral load of ≥100 000 copies/mL was associated with a shorter time to virological failure [multivariate hazard ratio (mHR) 7.84; P = 0.018] and longer time to viral suppression (mHR 0.46; P < 0.001). Time to viral suppression was shorter in patients receiving InSTI-based regimens (mHR 2.18; P = 0.006). Different InSTI-based regimens as initial treatment did not affect the treatment outcomes.
This study found an increasing trend of HIV-1 TDR prevalence from 2018 to 2020 in Taiwan. Baseline HIV-1 viral load and receiving InSTI-based regimens are important factors associated with time to virological failure or viral suppression.
整合酶 strand 转移抑制剂（INSTI）为基础的方案已成为台湾地区 HIV-1 感染患者的主要一线治疗方法。传播药物耐药性（TDR）和一些临床特征与病毒学失败或病毒抑制的时间有关；然而，这些在台湾尚未得到研究。
确定几种因素对台湾地区 HIV-1 感染患者治疗结果的影响。
该队列包括 2018 年至 2020 年期间台湾地区的 164 例 HIV-1 初治患者。采集血样，使用斯坦福大学 HIV 药物耐药性数据库确定基因型药物耐药性。Cox 比例风险模型用于确定与病毒学失败或病毒抑制时间相关的因素。
台湾地区 TDR 的流行率为 27.4%，呈逐年上升趋势。与 NNRTIs 相关的 TDR 突变最为常见（21%），而与 INSTIs 相关的 TDR 仍处于相对较低水平（1.3%）。基线 HIV-1 病毒载量≥100000 拷贝/mL 与病毒学失败时间缩短相关（多变量风险比[mHR]7.84；P=0.018），病毒抑制时间延长（mHR 0.46；P<0.001）。接受 INSTI 为基础的方案治疗的患者病毒抑制时间更短（mHR 2.18；P=0.006）。不同的 INSTI 为基础的方案作为初始治疗不会影响治疗结果。
本研究发现，2018 年至 2020 年期间，台湾地区 HIV-1 TDR 的流行率呈上升趋势。基线 HIV-1 病毒载量和接受 INSTI 为基础的方案是与病毒学失败或病毒抑制时间相关的重要因素。
