在中国深圳，新诊断的原发性 HIV 感染中，暴露前预防和暴露后预防的接种率较低，传播耐药性的患病率较高：一项真实世界的回顾性研究。

Low rate of pre-exposure prophylaxis and post-exposure prophylaxis uptake and high prevalence of transmitted drug resistance among newly diagnosed primary HIV infections in Shenzhen, China: a real-world retrospective study.

机构信息

National Clinical Research Center for Infectious Diseases, HKU AIDS Institute Shenzhen Research Laboratory, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong 518112, China.

National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.

出版信息

Chin Med J (Engl). 2022 Nov 20;135(22):2730-2737. doi: 10.1097/CM9.0000000000002510.

DOI:10.1097/CM9.0000000000002510

PMID:36719360

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9945328/

Abstract

BACKGROUND

Understanding the characteristics of newly diagnosed primary human deficiency virus-1 (HIV-1) infection in the context of the post-antiretroviral therapy era and HIV drug prophylaxis is essential for achieving the new target of 95-95-95-95 by 2025. This study reported the characteristics of newly diagnosed primary HIV-1 infection in Shenzhen.

METHODS

This is a real-world retrospective study. Eighty-seven newly diagnosed primary HIV-1-infected patients were recruited from January 2021 to March 2022 at the Third People's Hospital of Shenzhen. Demographic, epidemiological, diagnostic, drug resistance, and medical data were described and analyzed.

RESULTS

Overall, 96.6% (84/87) of the newly identified primary HIV-1-infected patients were male, including 88.5% (77/87) men have sex with men (MSM), with a median age of 29.0 years (Q1-Q3: 24.0-34.0 years); of these, 85.1% (74/87) reported high-risk sexual behaviors with casual partners. The rate of condom usage was only 28.7% (25/87). The overall rate of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) was 8.0% (7/87, including 4 PrEP and 3 PEP cases) around the potential exposure, although 41.4% of the patients had prior awareness of such interventions. Moreover, only 19.5% (17/87) had previously used PrEP or PEP. Of those, 58.8% (10/17) of the patients obtained drugs from the internet, and only 35.3% (6/17) reported good compliance. A total of 54.0% (47/87) of subjects were diagnosed by the HIV nucleic acid test. Acute retroviral syndrome appeared in 54.0% (47/87) of patients. The prevalence of transmitted drug resistance (TDR) mutation was 33.9% (19/56), including 6 (10.7%) against nucleoside reverse transcriptase inhibitor (NRTI) plus non-nucleoside reverse transcriptase inhibitor (NNRTI), 8 (14.3%) against NNRTI, and 5 (8.9%) against protease inhibitor (PI) only.

CONCLUSIONS

Owing to the low utilization rate and incorrect usage of PrEP and PEP, massive efforts are needed to promote HIV-preventive strategies in the MSM population. The extremely high prevalence of TDR mutation in this population implies the need for future pretreatment drug resistance surveillance.

摘要

背景

了解抗逆转录病毒治疗时代和 HIV 药物预防背景下新诊断原发性人类免疫缺陷病毒 1 型（HIV-1）感染的特征，对于实现到 2025 年达到 95-95-95-95 的新目标至关重要。本研究报告了深圳市新诊断原发性 HIV-1 感染的特征。

方法

这是一项真实世界的回顾性研究。2021 年 1 月至 2022 年 3 月，从深圳市第三人民医院招募了 87 例新诊断的原发性 HIV-1 感染患者。描述和分析了人口统计学、流行病学、诊断、耐药性和医疗数据。

结果

总体而言，96.6%（87/87）的新确诊原发性 HIV-1 感染患者为男性，包括 88.5%（77/87）男男性行为者（MSM），中位年龄 29.0 岁（Q1-Q3：24.0-34.0 岁）；其中 85.1%（74/87）报告与偶然伴侣发生高危性行为。避孕套使用率仅为 28.7%（25/87）。虽然 41.4%的患者事先了解过此类干预措施，但周围潜在暴露时的预防用药（PrEP）和暴露后预防（PEP）总体率为 8.0%（7/87，包括 4 例 PrEP 和 3 例 PEP 病例）。此外，只有 19.5%（17/87）之前使用过 PrEP 或 PEP。其中，58.8%（10/17）的患者从互联网获取药物，只有 35.3%（6/17）报告了良好的依从性。共有 54.0%（47/87）的患者通过 HIV 核酸检测确诊。54.0%（47/87）的患者出现急性逆转录病毒综合征。传播耐药性（TDR）突变的流行率为 33.9%（19/56），包括 6 例（10.7%）针对核苷逆转录酶抑制剂（NRTI）加非核苷逆转录酶抑制剂（NNRTI）、8 例（14.3%）针对 NNRTI、5 例（8.9%）仅针对蛋白酶抑制剂（PI）。