Soulie Cathia, Agher Rachid, Fauchois Antoine, Abdi Basma, Wirden Marc, Teyssou Elisa, Sayon Sophie, Katlama Christine, Valantin Marc-Antoine, Tubiana Roland, Schneider Luminita, Faycal Antoine, Palich Romain, Pourcher Valérie, Marcelin Anne-Geneviève, Calvez Vincent
INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, laboratoire de virologie, Sorbonne Université, Paris, France.
INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, service de maladies infectieuses, Sorbonne Université, Paris, France.
J Antimicrob Chemother. 2025 Mar 3;80(3):697-700. doi: 10.1093/jac/dkae458.
We aimed to determine how non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance profiles have changed over the last decade in people living with HIV (PLWHIV) experiencing virological failure on all antiretroviral treatments, including different NNRTIs.
We analysed the use of the different NNRTIs in PLWHIV treated with antiretroviral drugs at an academic centre and the HIV NNRTI resistance profiles observed in cases of virological failure over the last 10 years (2014-23). We used the latest ANRS-MIE algorithm (v33; https://hivfrenchresistance.org/) to analyse the resistance mutation profiles of the HIV reverse transcriptase sequences.
During this period, the frequency of NNRTI use remained high, fluctuating slightly between 43.5% (n = 1782/4094) and 39.9% (n = 1758/4421). The use of efavirenz (10.8%-1.5%), nevirapine (7.0%-1.2%), and etravirine (11.0%-1.1%) decreased, whereas the use of rilpivirine (14.7%-26.3%) and doravirine (available from 2018, rising to 9.7% in 2023) increased. These trends were statistically significant for etravirine (P = 0.033) and rilpivirine (P < 0.001). Resistance rates for efavirenz, nevirapine and rilpivirine remained above 15% (efavirenz: 17.3%-16.6%, nevirapine: 16.9%-15.4% and rilpivirine: 17.6%-16.1%). This reflects significant cross-resistance between these three NNRTIs. By contrast, resistance rates were lower for etravirine (7.8%-6.0%) and doravirine (4.9%-4.6%), probably due to differences in their resistance profiles and higher genetic barriers to resistance.
The NNRTI class of antiretroviral drugs remains widely used. Changes in the usage of drugs from this class have not altered the ecology of NNRTI resistance in antiretroviral drug-treated PLWHIV with virological failure during the studied period.
我们旨在确定在过去十年中，接受包括不同非核苷类逆转录酶抑制剂（NNRTI）在内的所有抗逆转录病毒治疗后出现病毒学失败的HIV感染者（PLWHIV）中，NNRTI耐药谱是如何变化的。
我们分析了在一个学术中心接受抗逆转录病毒药物治疗的PLWHIV中不同NNRTI的使用情况，以及过去10年（2014 - 2023年）病毒学失败病例中观察到的HIV NNRTI耐药谱。我们使用最新的ANRS - MIE算法（v33；https://hivfrenchresistance.org/）来分析HIV逆转录酶序列的耐药突变谱。
在此期间，NNRTI的使用频率仍然很高，在43.5%（n = 1782/4094）和39.9%（n = 1758/4421）之间略有波动。依非韦伦（10.8% - 1.5%）、奈韦拉平（7.0% - 1.2%）和依曲韦林（11.0% - 1.1%）的使用减少，而利匹韦林（14.7% - 26.3%）和多韦拉韦（2018年可用，2023年升至9.7%）的使用增加。这些趋势对于依曲韦林（P = 0.033）和利匹韦林（P < 0.001）具有统计学意义。依非韦伦、奈韦拉平和利匹韦林的耐药率仍高于15%（依非韦伦：17.3% - 16.6%，奈韦拉平：16.9% - 15.4%，利匹韦林：17.6% - 16.1%）。这反映了这三种NNRTI之间存在显著的交叉耐药性。相比之下，依曲韦林（7.8% - 6.0%）和多韦拉韦（4.9% - 4.6%）的耐药率较低，可能是由于它们的耐药谱不同以及耐药的遗传屏障较高。
抗逆转录病毒药物中的NNRTI类仍然被广泛使用。在研究期间，该类药物使用的变化并未改变接受抗逆转录病毒药物治疗且出现病毒学失败的PLWHIV中NNRTI耐药的生态情况。
