广西接受长期抗逆转录病毒治疗的儿童和青少年中HIV-1耐药突变的出现

Emergence of HIV-1 drug resistance mutations among children and adolescents undergoing prolonged antiretroviral therapy in Guangxi.

作者信息

Pang Xianwu, Lu Hongyan, He Qin, Tang Kailing, Ma Jie, Chen Siya, Huang Jinghua, Fang Ningye, Xie Haomin, Lan Guanghua, Liang Shujia

机构信息

Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Key Laboratory of AIDS Prevention Control and Translation, Guangxi Zhuang Autonomous Region Centre for Disease Control and Prevention, Nanning, Guangxi, China; Guangxi Zhuang Autonomous Region Academy of Preventive Medicine, Nanning, Guangxi, China.

Guangxi Zhuang Autonomous Region Academy of Preventive Medicine, Nanning, Guangxi, China; AIDS Care Clinic, Guangxi Zhuang Autonomous Region Centre for Disease Control and Prevention, Nanning, Guangxi, China.

出版信息

J Glob Antimicrob Resist. 2024 Jun;37:208-213. doi: 10.1016/j.jgar.2024.03.013. Epub 2024 Apr 10.

DOI:10.1016/j.jgar.2024.03.013

PMID:38608935

Abstract

OBJECTIVE

Antiretroviral therapy (ART) has been implemented in Guangxi for a long time, and there are no reports of HIV drug resistance mutation (DRM) among children and adolescents experiencing virologic failure after ART. This study aimed to analyse HIV DRM prevalence, patterns, and influencing factors among children and adolescents experiencing virologic failure after ART in Guangxi.

METHODS

We collected samples from a total of 491 HIV-infected individuals under 18 years old experiencing virologic failure after ART from 14 cities in Guangxi. Sequencing and DRM analysis were performed based on pol region. Multivariate logistic regression was employed to analysis the influencing factors of DRM.

RESULTS

Among these patients, 396 cases were successfully sequenced. Of all, 52.53% exhibited HIV DRM, including NNRTI (48.48%), NRTI (34.85%) and PI (1.01%). NRTI and NNRTI dual-class resistance was prevalent (30.3%). M184V/I and K103N mutations were the common mutations in NRTI and NNRTI, respectively. Male sex (aOR = 2.1, 95% CI: 1.26-3.50), CRF01_AE subtype (OR = 2.50, 95% CI: 1.02-5.88), the primary regimen 3TC+AZT+NVP (OR = 10.00, 95% CI: 5.00-25.00), low pretreatment CD4+ T lymphocytes (<200 cells/mm³) (OR = 1.85, 95% CI: 1.00-3.45), and high viral load (>1000 copies/mL) (OR = 4.90, 95% CI: 1.03-23.39) showed higher risk of DRM.

CONCLUSION

HIV DRM is pervasive among children and adolescents experiencing virologic failure in Guangxi. Timely HIV DRM monitoring is crucial to mitigate major mutation accumulation and inform effective treatment strategies.

摘要

目的

广西实施抗逆转录病毒治疗（ART）已有很长时间，且尚无关于接受ART后病毒学治疗失败的儿童和青少年中HIV耐药性突变（DRM）的报道。本研究旨在分析广西接受ART后病毒学治疗失败的儿童和青少年中HIV DRM的流行情况、模式及影响因素。

方法

我们从广西14个城市共收集了491例18岁以下接受ART后病毒学治疗失败的HIV感染者的样本。基于pol区进行测序和DRM分析。采用多因素logistic回归分析DRM的影响因素。

结果

在这些患者中，396例成功测序。其中，52.53%出现HIV DRM，包括非核苷类逆转录酶抑制剂（NNRTI，48.48%）、核苷类逆转录酶抑制剂（NRTI，34.85%）和蛋白酶抑制剂（PI，1.01%）。NRTI和NNRTI双重耐药很普遍（30.3%）。M184V/I和K103N突变分别是NRTI和NNRTI中的常见突变。男性（调整后比值比[aOR]=2.1，95%置信区间[CI]：1.26-3.50）、CRF01_AE亚型（OR=2.50，95%CI：1.02-5.88）、初始治疗方案3TC+AZT+NVP（OR=10.00，95%CI：5.00-25.00）、治疗前CD4+T淋巴细胞计数低（<200个细胞/mm³）（OR=1.85，95%CI：1.00-3.45）以及病毒载量高（>1000拷贝/mL）（OR=4.90，95%CI：1.03-23.39）显示出更高的DRM风险。