299618Malawi Ministry of Health, Lilongwe, Malawi.
305040International Training & Education Centre for Health (I-TECH), Lilongwe, Malawi.
Antivir Ther. 2022 Aug;27(4):13596535221121225. doi: 10.1177/13596535221121225.
Information on HIV drug resistance (HIVDR) prevalence in people newly diagnosed with HIV is limited. We implemented a cross-sectional study to estimate HIVDR prevalence among pregnant women recently infected with HIV in Malawi.
The HIVDR study was nested within a routine antenatal clinic (ANC) sentinel surveillance survey. Dried blood spot samples were tested for recent infection using a limiting antigen antibody assay together with HIV viral load testing. HIV-1 protease and reverse transcriptase were sequenced using Sanger sequencing. Drug susceptibility was predicted using Stanford HIVdb algorithm (version 8.9). Weighted analysis was performed in Stata 15.1.
Of the 21,642 pregnant women enrolled in the ANC survey, 8.4% (1826/21,642) tested HIV positive. Of these, 5.0% (92/1826) had recent HIV infection, and 90.2% (83/92) were tested by PCR. The amplification and sequencing success rate was 57.8% (48/83). The prevalence of any HIVDR was 14.6% (5/45) (95% CI: 4.7-36.8%), all of which indicated HIVDR to nonnucleoside reverse transcriptase inhibitors (NNRTIs). HIVDR to nucleoside reverse transcriptase inhibitors was 7.9% (2/45) (95% CI: 1.4-34.6%). Resistance to protease inhibitors currently in use in Malawi was not observed.
Despite the low number of cases with presumed TDR, our study hints that resistance to NNRTIs was high, above the 10% target for regimen change. Further investigation is needed to establish the exact magnitude of presumed TDR among women recently infected with HIV. These findings support the transition to an integrase inhibitor-based first-line regimen for patients initiating or on ART.
有关新诊断出 HIV 感染者中 HIV 耐药性（HIVDR）流行率的信息有限。我们开展了一项横断面研究，以估计马拉维新近感染 HIV 的孕妇中 HIVDR 的流行率。
HIVDR 研究嵌套在常规产前检查（ANC）哨点监测调查中。使用限制抗原抗体检测法结合 HIV 病毒载量检测法检测近期感染情况，对干血斑样本进行检测。使用 Sanger 测序对 HIV-1 蛋白酶和逆转录酶进行测序。使用斯坦福 HIVdb 算法（版本 8.9）预测药物敏感性。在 Stata 15.1 中进行加权分析。
在参加 ANC 调查的 21642 名孕妇中，8.4%（1826/21642）检测 HIV 阳性。其中，5.0%（92/1826）有近期 HIV 感染，90.2%（83/92）通过 PCR 检测。扩增和测序成功率为 57.8%（48/83）。任何 HIVDR 的流行率为 14.6%（5/45）（95%CI：4.7-36.8%），均显示对非核苷类逆转录酶抑制剂（NNRTIs）的 HIVDR。核苷类逆转录酶抑制剂的 HIVDR 为 7.9%（2/45）（95%CI：1.4-34.6%）。未观察到对马拉维目前使用的蛋白酶抑制剂的耐药性。
尽管推定的 TDR 病例数量较少，但我们的研究表明，对 NNRTIs 的耐药性较高，超过了方案改变的 10%目标。需要进一步调查，以确定新近感染 HIV 的妇女中推定的 TDR 的确切程度。这些发现支持向整合酶抑制剂为基础的一线方案过渡，适用于开始或正在接受 ART 的患者。
