Cao Bianchuan, Liu Mei, Song Shaofang, Guo Mingxian, Tang Lingyu, Ding Ping, Yuan Tianru, Wang Tong, Zhong Li
Department of Infectious Disease, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Tuberculosis, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
AIDS Res Hum Retroviruses. 2025 Apr;41(4):197-202. doi: 10.1089/aid.2024.0088. Epub 2025 Jan 15.
In 2023, we published a case study involving a 10-year-old child infected with HIV-1 with low-level viremia (LLV). We showed that this child patient achieved successful viral suppression by modifying the antiretroviral therapy (ART) regimen according to the HIV-1 DNA genotypic drug resistance testing. In this study, we aimed to address whether HIV-1 DNA genotypic drug resistance testing could direct successfully virological suppression in patients infected with HIV-1 experiencing persistent LLV based on evidence from a cohort study. The subjects of this study were all people living with HIV-1 who received ART and followed in the Yuexi County (Liangshan, China) from December 2010 to February 2024. From June 2021 to February 2024, a total of 10 mL of peripheral blood was collected from each subject at each follow-up and separated. HIV-1 RNA and HIV-1 DNA were quantified, followed by HIV-1 genotypic drug resistance testing. ART regimens were accordingly adjusted, while follow-up tests were performed in terms of HIV-1 RNA and DNA measurements. The prevalent HIV-1 DNA drug resistance mutations (DRMs) included M184V, K103N, K101E/P, and V108I. The primary resistance mutations observed for nucleoside reverse transcriptase inhibitor (NRTI) were against abacavir, lamivudine, and emtricitabine. For non-NRTI, the primary DRMs were associated with efavirenz and nevirapine. Five out of the six patients were subjected to regimen adjustments according to HIV-1 DNA DRMs, while one patient was continuously treated with unchanged regimen. Viral suppression was achieved in all five ART-changed cases, with observation of remarkable of HIV-1 DNA decline. The ART-unchanged case showed progressive treatment failure with drastic increase of plasma HIV-1 RNA and whole blood HIV-1 DNA. For patients with LLV, HIV-1 DNA genotypic drug resistance testing directed ART regimen considerations are highly recommended for achieving viral suppression.
2023年，我们发表了一项病例研究，涉及一名感染HIV-1且病毒血症水平较低（LLV）的10岁儿童。我们表明，该儿童患者通过根据HIV-1 DNA基因型耐药性检测调整抗逆转录病毒治疗（ART）方案，实现了病毒的成功抑制。在本研究中，我们旨在根据一项队列研究的证据，探讨HIV-1 DNA基因型耐药性检测能否指导持续存在LLV的HIV-1感染者成功实现病毒学抑制。本研究的对象为2010年12月至2024年2月期间在越西县（中国凉山）接受ART治疗并接受随访的所有HIV-1感染者。2021年6月至2024年2月，在每次随访时从每个研究对象中采集10 mL外周血并进行分离。对HIV-1 RNA和HIV-1 DNA进行定量，随后进行HIV-1基因型耐药性检测。相应调整ART方案，同时就HIV-1 RNA和DNA测量进行随访检测。常见的HIV-1 DNA耐药性突变（DRMs）包括M184V、K103N、K101E/P和V108I。观察到的核苷类逆转录酶抑制剂（NRTI）的主要耐药性突变针对阿巴卡韦、拉米夫定和恩曲他滨。对于非核苷类逆转录酶抑制剂，主要的DRMs与依非韦伦和奈韦拉平有关。6名患者中有5名根据HIV-1 DNA DRMs进行了方案调整，而1名患者继续接受未改变的方案治疗。所有5例改变ART方案的病例均实现了病毒抑制，观察到HIV-1 DNA显著下降。未改变ART方案的病例显示治疗逐渐失败，血浆HIV-1 RNA和全血HIV-1 DNA急剧增加。对于LLV患者，强烈建议进行HIV-1 DNA基因型耐药性检测以指导ART方案的制定，以实现病毒抑制。
