在南非，接受抗逆转录病毒治疗（ART）失败的儿科患者中，耐药情况很常见。

Resistance is common in paediatric patients failing ART in South Africa.

机构信息

Centre for HIV and STIs, National Institute for Communicable Diseases, Private Bag X4, Sandringham, Johannesburg 2131, South Africa.

Department of Virology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

出版信息

J Antimicrob Chemother. 2023 May 3;78(5):1160-1167. doi: 10.1093/jac/dkac443.

DOI:10.1093/jac/dkac443

PMID:37017009

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10616358/

Abstract

BACKGROUND

Minimal data exist on HIV drug resistance patterns and prevalence among paediatric patients failing ART in resource-limited settings. We assessed levels of HIV drug resistance in children with virological failure.

METHODS

This cross-sectional study, performed from March 2017 to March 2019 in South Africa, enrolled HIV-positive children aged ≤19 years, receiving ART through public health facilities with recent evidence suggestive of virological failure (at least one viral load ≥1000 copies/mL), across 45 randomly selected high-volume clinics from all nine provinces. Resistance genotyping was performed using next-generation sequencing technologies. Descriptive analysis taking into account survey design was used to determine outcomes.

RESULTS

Among 899 participants enrolled, the adjusted proportion of HIV drug resistance among children with virological failure was 87.5% (95% CI 83.0%-90.9%). Resistance to NNRTIs was detected in 77.4% (95% CI 72.5%-81.7%) of participants, and resistance to NRTIs in 69.5% (95% CI 62.9%-75.4%) of participants. Overall, resistance to PIs was detected in 7.7% (95% CI 4.4%-13.0%) of children.

CONCLUSIONS

HIV drug resistance was highly prevalent in paediatric patients failing ART in South Africa, with 9 in 10 patients harbouring resistance to NNRTIs and/or NRTIs. PI-based regimens are predicted to be highly efficacious in achieving virological suppression amongst patients failing NNRTI-based regimens. Scaling up resistance testing amongst patients would facilitate access to second- and third-line regimens in South Africa.

摘要

背景

在资源有限的环境中，关于失败接受抗逆转录病毒疗法（ART）的儿科患者的 HIV 耐药模式和流行情况的数据极少。我们评估了病毒学失败的儿童中 HIV 耐药的水平。

方法

这是一项横断面研究，于 2017 年 3 月至 2019 年 3 月在南非进行，纳入了在公立卫生机构接受 ART 治疗的年龄≤19 岁的 HIV 阳性儿童，他们的最近病毒载量检测结果提示病毒学失败（至少有一次病毒载量≥1000 拷贝/ml），研究在来自所有 9 个省的 45 家随机选择的大容量诊所进行。采用下一代测序技术进行耐药基因分型。采用考虑到调查设计的描述性分析来确定结果。

结果

在纳入的 899 名参与者中，病毒学失败的儿童中 HIV 耐药的调整比例为 87.5%（95%CI 83.0%-90.9%）。77.4%（95%CI 72.5%-81.7%）的参与者检测到 NNRTI 耐药，69.5%（95%CI 62.9%-75.4%）的参与者检测到 NRTI 耐药。总体而言，7.7%（95%CI 4.4%-13.0%）的儿童检测到对 PI 的耐药。