Suppr
超能文献

2017-2020 年德国新报告 HIV 诊断病例中病毒传播耐药性和亚型模式。

Transmitted drug resistance and subtype patterns of viruses from reported new HIV diagnoses in Germany, 2017-2020.

机构信息

Unit 18 "HIV and other Retroviruses, Sexually transmitted bacterial Pathogens (STI) and HIV", Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany.

Unit 18 "HIV and other Retroviruses", Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany.

出版信息

BMC Infect Dis. 2023 Oct 10;23(1):673. doi: 10.1186/s12879-023-08649-3.

DOI:10.1186/s12879-023-08649-3

PMID:37817087

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10563336/

Abstract

BACKGROUND

The transmission of resistant HIV variants jeopardizes the effective use of antiretrovirals for therapy and prophylaxis. Molecular surveillance of new HIV diagnoses with a focus on prevalence and type of resistance associated mutations and the subtype of circulating viruses is mandatory.

METHOD

From 2017 to 2020, 11,527 new HIV diagnoses were reported in Germany to the Robert Koch Institute (RKI). Protease (PR) and reverse-transcriptase (RT) sequences were obtained from 4559 (39.6%) cases, and PR, RT and integrase (IN) sequences were obtained from 3097 (26.9%) cases. The sequences were analyzed with data from the national HIV reports.

RESULTS

Among all cases in the analysis, the proportion of primary resistance was 4.3% for nucleoside reverse-transcriptase inhibitors (NRTIs), 9.2% for non-NRTI (NNRTIs), 3.3% for protease inhibitors (PIs) and 1.4% for integrase inhibitors (INIs). Dual-class resistance was highest for NRTIs/NNRTIs with 1.2%. There was no trend in the proportion of viruses resistant to drug classes. Most individual key mutations associated with relevant resistance had a prevalence below 1% including K65R (0.1%) and M184V (0.6%). A notable exception was K103NS, with a prevalence of 2.9% and a significant increase (p=0.024) during 2017-2020. In this period, diagnoses of infections with HIV-1 subtype B were the most common at 58.7%, but its prevalence was declining (p=0.049) while the frequency of minority subtypes (each < 1%) increased (p=0.007). Subtype B was highest (75.6%) in men who have sex with men (MSM) and lowest in reported heterosexual transmissions (HETs, 22.6%).

CONCLUSION

The percentage of primary resistance was high but at a stable level. A genotypic determination of resistance is therefore still required before the start of therapy. The subtype diversity of circulating HIV-1 is increasing.

摘要

背景

耐药 HIV 变异体的传播危及抗逆转录病毒疗法和预防的有效应用。对新的 HIV 诊断进行分子监测，重点关注耐药相关突变的流行率和类型以及循环病毒的亚型，是强制性的。

方法

2017 年至 2020 年，德国罗伯特·科赫研究所（RKI）报告了 11527 例新的 HIV 诊断病例。从 4559 例（39.6%）病例中获得了蛋白酶（PR）和逆转录酶（RT）序列，从 3097 例（26.9%）病例中获得了 PR、RT 和整合酶（IN）序列。这些序列与国家 HIV 报告中的数据进行了分析。

结果

在分析中的所有病例中，核苷逆转录酶抑制剂（NRTIs）的原发性耐药比例为 4.3%，非核苷逆转录酶抑制剂（NNRTIs）为 9.2%，蛋白酶抑制剂（PIs）为 3.3%，整合酶抑制剂（INIs）为 1.4%。双重耐药率最高的是 NRTIs/NNRTIs，为 1.2%。耐药药物种类的比例没有趋势。与相关耐药性相关的大多数个别关键突变的流行率均低于 1%，包括 K65R（0.1%）和 M184V（0.6%）。一个显著的例外是 K103NS，其流行率为 2.9%，在 2017-2020 年期间显著增加（p=0.024）。在此期间，感染 HIV-1 亚型 B 的诊断最为常见，占 58.7%，但其流行率正在下降（p=0.049），而少数亚型（每种<1%）的频率正在增加（p=0.007）。B 亚型在男男性行为者（MSM）中最高（75.6%），在报告的异性恋传播（HETs）中最低（22.6%）。