津巴布韦开始使用替诺福韦、拉米夫定和度鲁特韦的初治个体中，预先存在的和获得性的对度鲁特韦耐药率低。
Low Prevalence of Pre-Treatment and Acquired Drug Resistance to Dolutegravir among Treatment Naïve Individuals Initiating on Tenofovir, Lamivudine and Dolutegravir in Zimbabwe.
机构信息
Unit of Internal Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare P.O. Box A178, Zimbabwe.
Biomedical Research and Training Institute, Harare P.O. Box A178, Zimbabwe.
出版信息
Viruses. 2023 Sep 5;15(9):1882. doi: 10.3390/v15091882.
Dolutegravir (DTG) use in combination with tenofovir and lamivudine (TLD) is scaling up in Africa. However, HIV drug resistance (HIVDR) data to DTG remain scarce in Zimbabwe. We assessed the prevalence and genetic mechanisms of DTG resistance in people living with HIV initiating on TLD. A prospective cohort study was conducted between October 2021 and April 2023 among antiretroviral therapy (ART) naïve adults (≥18 years) attending care at an HIV clinic in Zimbabwe. Pre-treatment drug resistance (PDR) was assessed prior to TLD initiation and viral load (VL) outcome and acquired drug resistance (ADR) to TLD were described after 24 weeks follow-up. In total, 172 participants were enrolled in the study. The median (IQR) age and log VL were 39 (29-48) years and 5.41 (4.80-5.74) copies/mL, respectively. At baseline, no PDR to DTG was found. However, as previously reported, PDR to non-nucleotide reverse transcriptase inhibitor (NNRTI) was high (15%) whilst PDR to NRTI was low (4%). After a median duration of 27 (25-30) weeks on TLD, virological suppression (VL < 1000 copies/mL) was 98% and among the 2 participants with VL ≥ 1000 copies/mL, no ADR was found. HIVDR to DTG is rare among ART naïve individuals. DTG is more likely to address the problems of HIVDR in Africa.
多替拉韦（DTG）与替诺福韦和拉米夫定（TLD）联合使用在非洲不断推广。然而，津巴布韦的 HIV 耐药性（HIVDR）数据仍然缺乏关于 DTG 的数据。我们评估了在开始 TLD 治疗的 HIV 感染者中 DTG 耐药的流行率和遗传机制。一项前瞻性队列研究于 2021 年 10 月至 2023 年 4 月在津巴布韦的一家 HIV 诊所进行，纳入了接受抗逆转录病毒治疗（ART）的初治成年人（≥18 岁）。在开始 TLD 治疗之前评估了预先存在的药物耐药性（PDR），并在 24 周随访后描述了对 TLD 的获得性耐药（ADR）。共有 172 名参与者入组了这项研究。参与者的中位（IQR）年龄和对数病毒载量（VL）分别为 39（29-48）岁和 5.41（4.80-5.74）拷贝/mL。基线时，未发现对 DTG 的 PDR。然而，正如之前报道的，对非核苷酸逆转录酶抑制剂（NNRTI）的 PDR 较高（15%），而对 NRTI 的 PDR 较低（4%）。在开始 TLD 治疗后的中位时间为 27（25-30）周后，病毒学抑制（VL < 1000 拷贝/mL）率为 98%，在 2 名 VL ≥ 1000 拷贝/mL 的参与者中，未发现 ADR。在初治人群中，对 DTG 的 HIVDR 罕见。DTG 更有可能解决非洲 HIVDR 的问题。
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