Morey Francis, Girón-Callejas Amalia, Manzanero Russell, Urbina Aspiro, García-Morales Claudia, Joseph Job, Bolastig Edwin, Jones Sandra, Wu Stephanie M, Tapia-Trejo Daniela, Monreal-Flores Jessica, Ortega Veronica, Manzanero Marvin, Sosa Aldo, Ravasi Giovanni, Jordan Michael R, Sued Omar, Ávila-Ríos Santiago
Hospital Services and Allied Health, Ministry of Health and Wellness, Belmopan, Belize.
Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City 14080, Mexico.
J Antimicrob Chemother. 2025 Jan 3;80(1):292-300. doi: 10.1093/jac/dkae408.
The rising prevalence of pretreatment drug resistance (PDR) to non-nucleoside reverse-transcriptase inhibitors threatens the effectiveness of ART. In response, the WHO recommends dolutegravir-based ART regimens due to their high genetic barrier to resistance and better treatment outcomes. This is expected to contribute to achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) target of 95% viral suppression in people on ART.
To estimate the prevalence of PDR among adults initiating ART and assess viral suppression and acquired HIV drug resistance (ADR) among individuals receiving ART in Belize.
Nationally representative cross-sectional PDR and ADR surveys were conducted between 2021 and 2022. Sixty-seven adults were included in the PDR survey, and 43 children and adolescents and 331 adults were included in the ADR survey. Demographic and clinic data and blood specimens were collected. HIV drug resistance (HIVDR) was predicted using the Stanford HIVdb tool.
The prevalence of PDR to efavirenz or nevirapine in adults was 49.3% (95% CI 42.2%-56.4%) and was significantly higher in those with previous antiretroviral exposure (OR: 7.16; 95% CI 2.71-18.95; P = 0.002). Among children and adolescents receiving ART, 50.0% had viral suppression, with better rates for those receiving dolutegravir-based ART (OR: 5.31; 95% CI 3.02-9.34; P < 0.001). In adults, 79.6% achieved viral suppression. No resistance to integrase inhibitors was observed in those on dolutegravir-based ART.
Prioritizing dolutegravir-based ART is critical for achieving HIV epidemic control in Belize. Efforts should focus on retention in care and adherence support to prevent HIVDR.
对非核苷类逆转录酶抑制剂的治疗前耐药性（PDR）患病率不断上升，威胁着抗逆转录病毒治疗（ART）的有效性。作为应对措施，世界卫生组织推荐基于多替拉韦的ART方案，因为其对耐药性具有较高的遗传屏障且治疗效果更佳。这有望有助于实现联合国艾滋病规划署（UNAIDS）提出的让接受ART治疗的人群中95%实现病毒抑制的目标。
估计在伯利兹开始接受ART治疗的成年人中PDR的患病率，并评估接受ART治疗的个体的病毒抑制情况及获得性HIV耐药性（ADR）。
在2021年至2022年期间开展了具有全国代表性的PDR和ADR横断面调查。PDR调查纳入了67名成年人，ADR调查纳入了43名儿童和青少年以及331名成年人。收集了人口统计学和临床数据以及血液样本。使用斯坦福HIV数据库工具预测HIV耐药性（HIVDR）。
成年人中对依非韦伦或奈韦拉平的PDR患病率为49.3%（95%置信区间42.2%-56.4%），既往接受过抗逆转录病毒治疗的人群中该患病率显著更高（比值比：7.16；95%置信区间2.71-18.95；P = 0.002）。在接受ART治疗的儿童和青少年中，50.0%实现了病毒抑制，接受基于多替拉韦的ART治疗的儿童和青少年的病毒抑制率更高（比值比：5.31；95%置信区间3.02-9.34；P < 0.001）。在成年人中，79.6%实现了病毒抑制。接受基于多替拉韦的ART治疗的人群中未观察到对整合酶抑制剂的耐药性。
优先使用基于多替拉韦的ART对于在伯利兹实现HIV疫情控制至关重要。应努力聚焦于持续治疗及依从性支持，以预防HIVDR。
