评估中东和北非地区的艾滋病毒耐药性及其相关因素：一项系统综述。

Evaluating HIV drug resistance in the middle East and North Africa and its associated factors: a systematic review.

作者信息

Khodadad Nastaran, Hashempour Ava, Nazar Mohamad Matin Karbalaei Ali, Ghasabi Farzaneh

机构信息

HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

出版信息

Virol J. 2025 Apr 22;22(1):112. doi: 10.1186/s12985-025-02740-8.

DOI:10.1186/s12985-025-02740-8

PMID:40264168

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12016335/

Abstract

OBJECTIVE

One of the obstacles to achieving successful treatment of HIV infections is the development and spread of mutations linked to resistance. Thus, it is important to monitor the prevalence and occurrence of drug resistance in HIV consistently. This study aimed to investigate how drug resistance affects the effectiveness of ART.

METHODS

This systematic review focused on surveying ART resistance in both treatment-naïve and treatment-experienced PWH from 2004 to 2024.

RESULTS

Out of 101 potential publications, 41 studies were included in this review. ART-experienced PWH in MENA countries commonly receive a regimen consisting of two NRTI drugs in combination with one NNRTI drug. The most frequent mutations were found in NRTIs (M184V, D67N, V75M, M41L, and T69N), NNRTIs (K103N, K101E, V106A, and G190S), and PIs (M36I and H69K). The ART-experienced groups in Israel and Iran presented the highest rates of resistance, reaching 52.78% and 43.03%, respectively, whereas the ART-naïve group in Turkey presented a resistance rate of 53.57%. The most prevalent HIV-1 subtypes in the region were B, CRF35-AD, CRF01-AE, A1, CR02-AG, C, and D. A high frequency of drug resistance mutations, such as M184V and K103N/S, was observed in the CRF35-AD, A, and C subtypes.

CONCLUSION

This is the first report to provide deep insight into ART resistance patterns in the MENA region among both ART-naïve and ART-experienced PWH. The results revealed a significant occurrence of drug resistance to RTIs, PIs, and INSTIs among both groups. This finding highlights the importance of prescribing the INTIs in native and PWH with resistance to RTIs and/or PIs to increase the chance of response to ART as well as regular monitoring of resistance to ART in MENA countries. This also involves identifying the key factors contributing to drug resistance, including inadequate adherence to ART and a lack of adequate monitoring systems to prevent treatment failure. Since the MENA region is significant as an economic challenge, PWH with poor adherence to ART medication and insufficient monitoring systems may hinder successful infection control; therefore, HIV control strategies may prevent viruses from spreading in other countries.

CLINICAL TRIAL NUMBER

Not applicable.

摘要

目的

实现艾滋病病毒（HIV）感染成功治疗的障碍之一是与耐药性相关的突变的产生和传播。因此，持续监测HIV耐药性的流行情况和发生情况非常重要。本研究旨在调查耐药性如何影响抗逆转录病毒治疗（ART）的效果。

方法

本系统评价聚焦于调查2004年至2024年期间初治和经治HIV感染者（PWH）的ART耐药情况。

结果

在101篇潜在出版物中，本评价纳入了41项研究。中东和北非（MENA）地区有ART治疗经验的PWH通常接受由两种核苷类逆转录酶抑制剂（NRTI）药物与一种非核苷类逆转录酶抑制剂（NNRTI）药物组成的治疗方案。最常见的突变出现在NRTIs（M184V、D67N、V75M、M41L和T69N）、NNRTIs（K103N、K101E、V106A和G190S）以及蛋白酶抑制剂（PIs）（M36I和H69K）中。以色列和伊朗有ART治疗经验的组呈现出最高的耐药率，分别达到52.78%和43.03%，而土耳其的初治组耐药率为53.57%。该地区最常见的HIV-1亚型为B、CRF35-AD、CRF01-AE、A1、CR02-AG、C和D。在CRF35-AD、A和C亚型中观察到高频率的耐药突变，如M184V和K103N/S。

结论

这是第一份深入洞察MENA地区初治和经治PWH中ART耐药模式的报告。结果显示两组中对核苷类逆转录酶抑制剂、蛋白酶抑制剂和整合酶链转移抑制剂（INSTIs）均存在显著的耐药情况。这一发现凸显了在初治和对核苷类逆转录酶抑制剂和/或蛋白酶抑制剂耐药的PWH中使用整合酶链转移抑制剂以增加ART反应机会以及在MENA国家定期监测ART耐药性的重要性。这还涉及确定导致耐药性的关键因素，包括对ART的依从性不足以及缺乏足够的监测系统以防止治疗失败。由于MENA地区在经济方面具有重要意义，对ART药物依从性差且监测系统不足的PWH可能会阻碍成功的感染控制；因此，HIV控制策略可能会防止病毒在其他国家传播。