Tran Giang Van, Hayashida Tsunefusa, Dang An Luong-Dieu, Nagai Moeko, Matsumoto Shoko, Tran Linh Khanh, Le Hoa Nguyen-Minh, Van Trang Dinh, Tanuma Junko, Pham Thach Ngoc, Oka Shinichi
Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam.
Department of Viral and Parasitic Diseases, National Hospital for Tropical Diseases, Hanoi, Vietnam.
Glob Health Med. 2024 Apr 30;6(2):117-123. doi: 10.35772/ghm.2023.01112.
Since the rapid expansion of antiretroviral therapy (ART) for HIV, transmitted drug resistance (TDR) has become a major concern in Vietnam. HIV services there are transitioning to be covered by social insurance. Access to pre-exposure prophylaxis (PrEP) is being expanded to tackle the growing HIV epidemic among men who have sex with men. Therefore, a cross-sectional study was conducted at 10 ART facilities in Northern Vietnam from 9 December 2019 to 9 June 2022 to investigate the prevalence and pattern of TDR among ART-naïve people living with HIV (PLWH). TDR mutations were defined according to the World Health Organization 2009 List of Mutations for Surveillance of Transmitted Drug Resistant HIV Strains. Mutation transmission dynamics and TDR clusters were investigated phylogenetic analysis. We enrolled 391 ART-naïve PLWH. The overall TDR prevalence was 4.6%, with an annual prevalence of 6.0% in 2019/2020, 4.8% in 2021, and 1.3% in 2022. TDR mutations to non-nucleoside reverse transcriptase inhibitors (2.8%), including K103N were the most common. Less commonly, the protease inhibitor-associated mutation M46I and mutations to nucleoside reverse transcriptase inhibitors, including M184V/ I, were observed. CRF01_AE was the most common subtype (77.0%). CRF07_BC (14.3%), which had been rare in Vietnam, was also observed. No genetic association was observed between HIV-1 sequences with TDR mutations. In conclusion, the overall prevalence of TDR was stably low in this region. The phylogenetic tree suggests that TDR clusters have not formed. Continuous monitoring of HIV TDR and strains is crucial to maintaining ART and PrEP efficacy.
自从抗逆转录病毒疗法（ART）在越南迅速推广用于治疗艾滋病毒以来，传播性耐药（TDR）已成为该国的一个主要问题。越南的艾滋病毒服务正逐渐纳入社会保险覆盖范围。暴露前预防（PrEP）的可及性正在扩大，以应对男男性行为者中不断增长的艾滋病毒疫情。因此，于2019年12月9日至2022年6月9日在越南北部的10个抗逆转录病毒治疗机构开展了一项横断面研究，以调查未接受过抗逆转录病毒治疗的艾滋病毒感染者（PLWH）中传播性耐药的流行情况和模式。传播性耐药突变根据世界卫生组织《2009年传播性耐药艾滋病毒毒株监测突变列表》进行定义。通过系统发育分析研究了突变传播动态和传播性耐药聚类情况。我们纳入了391名未接受过抗逆转录病毒治疗的艾滋病毒感染者。传播性耐药的总体流行率为4.6%，2019/2020年的年流行率为6.0%，2021年为4.8%，2022年为1.3%。对非核苷类逆转录酶抑制剂的传播性耐药突变（2.8%）最为常见，包括K103N。较少见的是与蛋白酶抑制剂相关的突变M46I以及对核苷类逆转录酶抑制剂的突变，包括M184V/I。CRF01_AE是最常见的亚型（77.0%）。还观察到CRF07_BC（14.3%），该亚型在越南曾较为罕见。未观察到具有传播性耐药突变的艾滋病毒-1序列之间存在遗传关联。总之，该地区传播性耐药的总体流行率一直较低。系统发育树表明尚未形成传播性耐药聚类。持续监测艾滋病毒的传播性耐药和毒株对于维持抗逆转录病毒疗法和暴露前预防的疗效至关重要。
