The Kirby Institute, University of New South Wales, Sydney, Australia.
New South Wales State Reference Laboratory - HIV/AIDS, St Vincent's Hospital, Sydney, Australia.
J Int AIDS Soc. 2024 Jul;27(7):e26308. doi: 10.1002/jia2.26308.
New South Wales (NSW) has one of the world's highest uptake rates of HIV pre-exposure prophylaxis (PrEP). This uptake has been credited with sharp declines in HIV transmission, particularly among Australian-born gay and bisexual men. Concerns have been raised around the potential for the emergence of tenofovir (TFV) and XTC (lamivudine/emtricitabine) resistance in settings of high PrEP use. Such an emergence could also increase treatment failure and associated clinical outcomes among people living with HIV (PLHIV). Despite low levels of nucleoside reverse-transcriptase inhibitor (NRTI) resistance relating to PrEP use in clinical settings, there are few published studies describing the prevalence of NRTI resistance among people newly diagnosed with HIV in a setting of high PrEP use.
Using HIV antiretroviral drug resistance data linked to NSW HIV notifications records of people diagnosed from 1 January 2015 to 31 December 2021 and with HIV attributed to male-to-male sex, we described trends in TFV and XTC resistance. Resistance was identified using the Stanford HIV Drug Resistance genotypic resistance interpretation system. To focus on transmitted drug resistance, resistance prevalence estimates were generated using sequences taken less than 3 months post-HIV diagnosis. These estimates were stratified by timing of sequencing relative to the date of diagnosis, year of sequencing, birthplace, likely place of HIV acquisition, and stage of HIV at diagnosis.
Among 1119 diagnoses linked to HIV genomes sequenced less than 3 months following diagnosis, overall XTC resistance prevalence was 1.3%. Between 2015 and 2021, XTC resistance fluctuated between 0.5% to 2.9% and was 1.0% in 2021. No TFV resistance was found over the study period in any of the sequences analysed. Higher XTC resistance prevalence was observed among people with newly acquired HIV (evidence of HIV acquisition in the 12 months prior to diagnosis; 2.9%, p = 0.008).
In this Australian setting, TFV and XTC resistance prevalence in new HIV diagnoses remained low. Our findings offer further evidence for the safe scale-up of PrEP in high-income settings, without jeopardizing the treatment of those living with HIV.
新南威尔士州（NSW）是世界上 HIV 暴露前预防（PrEP）使用率最高的地区之一。这种高使用率被认为是 HIV 传播率急剧下降的原因，尤其是在澳大利亚出生的男同性恋和双性恋者中。人们担心在 PrEP 使用率较高的情况下，可能会出现替诺福韦（TFV）和 XTC（拉米夫定/恩曲他滨）耐药性。这种出现也可能会增加 HIV 感染者（PLHIV）的治疗失败和相关临床结局。尽管在临床环境中使用 PrEP 与低水平的核苷逆转录酶抑制剂（NRTI）耐药性相关，但很少有研究描述在 PrEP 使用率较高的环境中，新诊断出 HIV 的人群中 NRTI 耐药性的流行情况。
使用与 NSW HIV 通知记录相关联的 HIV 抗逆转录病毒药物耐药性数据，该记录包括 2015 年 1 月 1 日至 2021 年 12 月 31 日期间被诊断为 HIV 的人群，HIV 归因于男男性行为，我们描述了 TFV 和 XTC 耐药性的趋势。耐药性使用斯坦福 HIV 药物耐药性基因耐药性解释系统进行鉴定。为了关注传播耐药性，耐药性流行率估计是通过在 HIV 诊断后不到 3 个月采集的序列生成的。这些估计值根据测序与诊断日期的时间关系、测序年份、出生地、可能的 HIV 获得地点以及诊断时的 HIV 阶段进行分层。
在 1119 例与 HIV 基因组相关联的诊断中，有 1119 例在诊断后不到 3 个月内进行了测序，其中 XTC 耐药性总流行率为 1.3%。在 2015 年至 2021 年期间，XTC 耐药性在 0.5%至 2.9%之间波动，2021 年为 1.0%。在所分析的序列中，未发现任何 TFV 耐药性。在新诊断出的 HIV 人群中，XTC 耐药性流行率较高（在诊断前 12 个月内有 HIV 获得的证据；2.9%，p=0.008）。
在澳大利亚这种环境下，新诊断出的 HIV 中 TFV 和 XTC 耐药性的流行率仍然很低。我们的发现为在高收入环境中安全扩大 PrEP 提供了进一步的证据，而不会危及 HIV 感染者的治疗。
