Division of Infectious Diseases, Department of Internal Medicine, Jordan University Hospital, Amman, Jordan; Infectious Diseases and Vaccine Center, University of Jordan, Amman, Jordan.
Primary Health Care Directorate, Ministry of Health, Amman, Jordan.
Int J Infect Dis. 2024 Aug;145:107079. doi: 10.1016/j.ijid.2024.107079. Epub 2024 Apr 30.
Limited epidemiologic studies have been conducted in Jordan describing the HIV epidemic. This study aimed to address this gap to inform HIV prevention and control.
A nationally-representative cross-sectional study was conducted among adults living with HIV in Jordan. Laboratory testing included HIV viral load and next-generation-sequencing-based clinical genotype. Log-binomial regression estimated risk ratios (RRs) and 95% confidence intervals (CIs).
Among 231 (70%) participants, most were male (184/80%), and from Jordan (217/94%). Among 188 treatment-experienced-participants (>6 months), 165 (88%) were virally suppressed. High-level resistance was most frequent against nucleoside reverse transcriptase inhibitor (13/81%), and integrase-strand transfer inhibitor (INSTI) (10/62%) drugs among viremic (≥1000 HIV copies/mL) treatment-experienced participants with drug-resistant mutations (DRMs, n = 16). Common HIV subtypes (n = 43) were B (6/14%), A1 (5/12%), and CRF01_AE (5/12%); additionally, novel recombinant forms were detected. In multivariate analysis, independently higher risk for late diagnosis (n = 49) was observed with diagnosis through blood donation (vs check-up: RR 2.20, 95%CI 1.16-4.17) and earlier time-period of diagnosis (1986-2014 vs 2015-2021: RR 2.87, 95%CI 1.46-5.62).
Late diagnosis and INSTI resistance endanger national HIV prevention and treatment in Jordan-high-level resistance to INSTI suggests therapeutic drug monitoring is needed for treatment efficacy and conservation of treatment options.
在约旦，仅有少数关于艾滋病毒流行情况的流行病学研究。本研究旨在填补这一空白，为艾滋病毒的预防和控制提供信息。
在约旦，对成年艾滋病毒感染者进行了一项全国代表性的横断面研究。实验室检测包括艾滋病毒病毒载量和基于下一代测序的临床基因型。对数二项式回归估计风险比（RR）和 95%置信区间（CI）。
在 231 名（70%）参与者中，大多数为男性（184/80%），来自约旦（217/94%）。在 188 名接受治疗的经验丰富的参与者（>6 个月）中，165 名（88%）病毒得到抑制。在携带耐药突变（DRM，n=16）且病毒载量（≥1000 艾滋病毒拷贝/ml）的接受治疗的经验丰富的病毒血症患者中，最常见的耐药情况是对核苷逆转录酶抑制剂（NRTI）（13/81%）和整合酶抑制剂（INSTI）（10/62%）药物的耐药情况。常见的艾滋病毒亚型（n=43）为 B（6/14%）、A1（5/12%）和 CRF01_AE（5/12%）；此外，还检测到新的重组形式。在多变量分析中，通过献血（与体检相比：RR 2.20，95%CI 1.16-4.17）和更早的诊断时间（1986-2014 年与 2015-2021 年：RR 2.87，95%CI 1.46-5.62）进行诊断的参与者，其晚期诊断（n=49）的风险更高。
晚期诊断和 INSTI 耐药危及约旦国家艾滋病毒的预防和治疗-INSTI 的高水平耐药表明，为了治疗效果和治疗方案的保留，需要进行治疗药物监测。
