Balaji Sivaraman, Madhumathi J, Bhargava Aradhana, Singh Tanvi, Mahajan Nupur, Ambalkar Deepti, Aggarwal Sumit
Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research-Headquarters, New Delhi, India.
Apex Regional STD Centre, VMMC and Safdarjung Hospital, New Delhi, India.
Indian J Sex Transm Dis AIDS. 2022 Jan-Jun;43(1):13-19. doi: 10.4103/ijstd.ijstd_2_21. Epub 2022 Jun 7.
The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic still exists as a major global public health burden, especially in the middle- and low-income countries. Antiretroviral therapy (ART) remains a sole option to reduce the mortality and morbidity associated with this disease as no approved vaccine candidates are available. About 67% of the people living with HIV (PLHIV) have received the ART in 2019 worldwide. As a consequence of increased ART regimes, the prevalence of drug resistance mutations (DRM) also has been escalating and it would become a significant barrier in achieving the United Nations Programme on HIV/AIDS goal of eliminating HIV by 2030. So far, nucleoside reverse transcriptase inhibitors (NRTI), non-nucleoside reverse transcriptase inhibitors (NNRTI), and protease inhibitor-(PI) associated DRM have been reported across the globe with a considerable escalation in the annual prevalence rate of pretreatment NNRTI DRM. Conversely, NRTI-associated DRM is still under 5%, with a few scattered reports of significant increase from few countries such as southern and eastern Africa. Likewise, in India, the propositions of NRTI and NNRTI-associated DRM have increased since the commencement of the nationwide ART program in 2004. In agreement to the global trend, M1841/V, a type of NNRTI, remains as a dominant DRM among PLHIV. In this review, we tried to collate various mechanisms of DRM in PLHIV. In addition, patterns of HIV DRM in India and their future challenges on drug-related mutations have been discussed.
人类免疫缺陷病毒/获得性免疫缺陷综合征（HIV/AIDS）疫情仍是全球主要的公共卫生负担，尤其是在中低收入国家。由于尚无获批的候选疫苗，抗逆转录病毒疗法（ART）仍然是降低该疾病死亡率和发病率的唯一选择。2019年，全球约67%的艾滋病病毒感染者（PLHIV）接受了ART治疗。随着ART治疗方案的增加，耐药突变（DRM）的发生率也在不断上升，这将成为实现联合国艾滋病规划署到2030年消除HIV目标的重大障碍。到目前为止，全球已报告了与核苷类逆转录酶抑制剂（NRTI）、非核苷类逆转录酶抑制剂（NNRTI）和蛋白酶抑制剂（PI）相关的DRM，且治疗前NNRTI DRM的年发生率显著上升。相反，与NRTI相关的DRM仍低于5%，只有来自非洲南部和东部等少数国家的一些零星报告显示其显著增加。同样，在印度，自2004年全国ART项目启动以来，与NRTI和NNRTI相关的DRM发生率也有所上升。与全球趋势一致，M1841/V这种NNRTI类型仍然是PLHIV中占主导地位的DRM。在本综述中，我们试图梳理PLHIV中DRM的各种机制。此外，还讨论了印度HIV DRM的模式及其在药物相关突变方面面临的未来挑战。
