Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy.
Departmental Faculty, UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy.
J Antimicrob Chemother. 2024 Sep 3;79(9):2152-2162. doi: 10.1093/jac/dkae189.
Transmitted drug resistance (TDR) is still a critical aspect for the management of individuals living with HIV-1. Thus, its evaluation is crucial to optimize HIV care.
Overall, 2386 HIV-1 protease/reverse transcriptase and 1831 integrase sequences from drug-naïve individuals diagnosed in north and central Italy between 2015 and 2021 were analysed. TDR was evaluated over time. Phylogeny was generated by maximum likelihood. Factors associated with TDR were evaluated by logistic regression.
Individuals were mainly male (79.1%) and Italian (56.2%), with a median (IQR) age of 38 (30-48). Non-B infected individuals accounted for 44.6% (N = 1065) of the overall population and increased over time (2015-2021, from 42.1% to 51.0%, P = 0.002). TDR prevalence to any class was 8.0% (B subtype 9.5% versus non-B subtypes 6.1%, P = 0.002) and remained almost constant over time. Overall, 300 transmission clusters (TCs) involving 1155 (48.4%) individuals were identified, with a similar proportion in B and non-infected individuals (49.7% versus 46.8%, P = 0.148). A similar prevalence of TDR among individuals in TCs and those out of TCs was found (8.2% versus 7.8%, P = 0.707).By multivariable analysis, subtypes A, F, and CFR02_AG were negatively associated with TDR. No other factors, including being part of TCs, were significantly associated with TDR.
Between 2015 and 2021, TDR prevalence in Italy was 8% and remained almost stable over time. Resistant strains were found circulating regardless of being in TCs, but less likely in non-B subtypes. These results highlight the importance of a continuous surveillance of newly diagnosed individuals for evidence of TDR to inform clinical practice.
传播性耐药（TDR）仍然是管理 HIV-1 感染者的一个关键方面。因此，评估 TDR 对于优化 HIV 护理至关重要。
本研究共分析了 2015 年至 2021 年期间在意大利北部和中部新诊断的 2386 例 HIV-1 蛋白酶/逆转录酶和 1831 例整合酶序列。随着时间的推移评估 TDR。采用最大似然法生成系统发育。采用逻辑回归评估与 TDR 相关的因素。
患者主要为男性（79.1%）和意大利人（56.2%），中位（IQR）年龄为 38（30-48）岁。非 B 型感染者占总人群的 44.6%（N=1065），且呈逐年上升趋势（2015-2021 年，从 42.1%升至 51.0%，P=0.002）。对任何类别的 TDR 发生率为 8.0%（B 亚型为 9.5%，而非 B 亚型为 6.1%，P=0.002），且随着时间的推移基本保持不变。共发现 300 个传播簇（TCs），涉及 1155 名（48.4%）患者，B 型和非 B 型感染者的比例相似（49.7%比 46.8%，P=0.148）。在 TCs 和非 TCs 中的个体中，TDR 的发生率相似（8.2%比 7.8%，P=0.707）。多变量分析显示，A、F 和 CFR02_AG 亚型与 TDR 呈负相关。其他因素，包括是否属于 TCs，与 TDR 无显著相关性。
2015 年至 2021 年期间，意大利的 TDR 发生率为 8%，且随着时间的推移基本保持稳定。无论是否属于 TCs，都发现了耐药株的传播，但在非 B 型亚型中较少见。这些结果强调了对新诊断患者进行 TDR 持续监测以指导临床实践的重要性。
