Harjani Raj Gurubuxrai, Iyer Asha Krishnaraj, Chaurasia Ankita
Centre for Excellence in HIV/AIDS, Ashirwad Hospital, Maharashtra, India.
AIDS Research and Control Centre (ARCON-VCTC) Rajiv Gandhi Medical College and CSM Hospital Kalwa (Collaborative Program of Thane Municipal Corporation TMC, Government of Maharashtra, Maharashtra, India and the University of Texas, Houston, USA), Thane, Maharashtra, India.
Indian J Sex Transm Dis AIDS. 2022 Jul-Dec;43(2):150-155. doi: 10.4103/ijstd.ijstd_101_20. Epub 2022 Nov 17.
The aim of this study is to find out the proportion of treatment-naïve (Tn) and treatment-experienced (Te) patients experiencing HIV drug resistance (DR) to different classes of antiretrovirals (ARVs) being used for HIV treatment and their in class DR correlation.
A cross-sectional study was done on 109 HIV patients enrolled at a private hospital in Thane, India, from 2014 to 2019. All patients were tested for CD4 count, viral load, and resistance to ARVs.
Sixty-six patients were Tn and 43 patients were Te. Among Tn and Te patients, the percentage of high-level resistance (HLR) for nonnucleoside reverse transcriptase inhibitors (NNRTI) was 4.55% and 37.8%, respectively, for nucleoside reverse transcriptase inhibitors (NRTI) was 0.43% and 36.4%, respectively. No HLR was observed for protease inhibitors (PIs) among Tn patients, while Te patients showed 2.62% HLR. Tn and Te patients showed high susceptibility for Darunavir (98.48% and 95.34%, respectively) followed by Atazanavir and Lopinavir (96.96%, each and 90.69%, each). Tn patients showed HLR for Lamivudine and Emtricitabine (1.52%, each). Integrase Strand Transfer Inhibitors were susceptible (100%) in both Tn and Te patients. A positive correlation was observed for within class across ARVs.
An increased incidence of HLR was observed for NNRTI as compared to NRTI while PIs and integrase strand transfer inhibitors (INSTIs) demonstrated no HLR in either group of patients. When selecting a regimen for Tn patients consisting of NRTIs + NNRTIs genotypic DR test is essential. While with PIs or INSTIs its optional. Among Te patients, DR testing is recommended for all classes of drugs.
本研究旨在了解初治（Tn）和经治（Te）的HIV患者对用于HIV治疗的不同类别抗逆转录病毒药物（ARV）产生HIV耐药性（DR）的比例及其在类别内的DR相关性。
对2014年至2019年在印度塔那一家私立医院登记的109例HIV患者进行了横断面研究。所有患者均接受了CD4计数、病毒载量和对ARV的耐药性检测。
66例患者为初治患者，43例为经治患者。在初治和经治患者中，非核苷类逆转录酶抑制剂（NNRTI）的高水平耐药（HLR）百分比分别为4.55%和37.8%，核苷类逆转录酶抑制剂（NRTI）分别为0.43%和36.4%。初治患者中未观察到蛋白酶抑制剂（PI）的高水平耐药，而经治患者中高水平耐药率为2.62%。初治和经治患者对达芦那韦的敏感性较高（分别为98.48%和95.34%），其次是阿扎那韦和洛匹那韦（均为96.96%和90.69%）。初治患者对拉米夫定和恩曲他滨表现出高水平耐药（均为1.52%）。整合酶链转移抑制剂在初治和经治患者中均敏感（100%）。观察到各类ARV药物在类别内存在正相关。
与核苷类逆转录酶抑制剂相比，非核苷类逆转录酶抑制剂的高水平耐药发生率有所增加，而蛋白酶抑制剂和整合酶链转移抑制剂（INSTI）在两组患者中均未显示高水平耐药。为初治患者选择由核苷类逆转录酶抑制剂+非核苷类逆转录酶抑制剂组成的治疗方案时，基因型DR检测至关重要。而对于蛋白酶抑制剂或整合酶链转移抑制剂，检测为可选。对于经治患者，建议对所有类别药物进行DR检测。
