Clinical Center for HIV/AIDS, Department of Infection, Beijing Ditan Hospital, Peking University, Beijing, China; and.
Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
J Acquir Immune Defic Syndr. 2022 Oct 1;91(S1):S27-S34. doi: 10.1097/QAI.0000000000003039.
With the increasing coverage of antiretroviral therapy, concerns for the emergence and transmission of HIV drug resistance (HIVDR) are arising. HIVDR was divided into 5 levels: sensitive, potentially resistant, low resistant, intermediate resistant, and high resistant. Most of the articles on HIVDR involved low-level, intermediate-level, and high-level drug resistance to antiretroviral drug, and few articles deal with potential drug resistance. Treatment failure associated with the level of low-level, intermediate-level, and high-level resistance to antiretroviral drug has been reported. However, whether virological failure (VF) is related to potential resistance remains unclear. In this study, we aimed to describe the situation of potential resistance to antiretroviral drug and whether it is related to VF.
We analyzed the demographic, behavioral information, medical history, and drug resistance-associated mutation data from subjects. Drug resistance mutations at baseline and time of failure in patients suffering VF were detected by using the Vela automated next-generation sequencing platform. The χ2 test or Fisher exact test and logistic regression were used to assess the risk factors that contribute to VF in the potential drug-resistant people.
The prevalence of overall pretreatment drug resistance was 7.06% (233/3300), and the prevalence of pretreatment potential resistance was 8.79% (290/3300). All these patients with pretreatment potential first-line drugs resistance showed potential resistance to nonnucleoside reverse transcriptase inhibitors (NNRTIs), and some of them had potential drug resistance to NNRTIs and NRTIs or NNRTIs and PIs; among these patients, 94.71% (179/189) had V179 D/E mutations. The VF rate of first-line treatment for potentially resistant people is 17.99%. CD4+ T-cell count ≤200 cells/L at antiretroviral therapy initiation are risk factors for the failure of first-line treatment.
The prevalence of potential drug resistance among individuals with HIV and the VF rate of first-line treatment for potential drug-resistant people were high. To better optimize clinical management, prevention, and control of HIV, attention should be devoted to the potential resistance of nonnucleoside drugs.
随着抗逆转录病毒疗法的覆盖面不断扩大，人们对 HIV 耐药性（HIVDR）的出现和传播产生了担忧。HIVDR 分为 5 个级别：敏感、潜在耐药、低度耐药、中度耐药和高度耐药。大多数关于 HIVDR 的文章涉及抗逆转录病毒药物的低水平、中水平和高水平耐药性，很少有文章涉及潜在耐药性。已经报道了与抗逆转录病毒药物的低水平、中水平和高水平耐药性相关的治疗失败。然而，病毒学失败（VF）是否与潜在耐药性有关尚不清楚。在这项研究中，我们旨在描述抗逆转录病毒药物潜在耐药性的情况，以及它是否与 VF 有关。
我们分析了来自研究对象的人口统计学、行为信息、病史和耐药相关突变数据。使用 Vela 自动化下一代测序平台检测 VF 患者基线和失败时的耐药突变。采用 χ2 检验或 Fisher 确切检验和逻辑回归分析评估潜在耐药人群中与 VF 相关的危险因素。
总体预处理药物耐药率为 7.06%（233/3300），预处理潜在耐药率为 8.79%（290/3300）。所有这些预处理一线药物耐药的患者均表现出对非核苷类逆转录酶抑制剂（NNRTIs）的潜在耐药性，其中一些患者对 NNRTIs 和 NRTIs 或 NNRTIs 和 PIs 具有潜在耐药性；这些患者中，94.71%（179/189）存在 V179D/E 突变。潜在耐药人群一线治疗的 VF 率为 17.99%。抗逆转录病毒治疗开始时 CD4+T 细胞计数≤200 个/μl 是一线治疗失败的危险因素。
HIV 个体中潜在耐药性的流行率和潜在耐药人群一线治疗的 VF 率均较高。为了更好地优化 HIV 的临床管理、预防和控制，应关注非核苷类药物的潜在耐药性。
