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喀麦隆的艾滋病毒药物耐药性和遗传多样性:对一线治疗方案的影响

Joseph Fokam^1,2,3,4, Collins Ambe Chenwi^1,3,5, Valère Tala^1,3

¹Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Messa, Yaoundé P.O. Box 3077, Cameroon.

|July 29, 2023

概括

喀麦隆的高艾滋病毒耐药性降低了第一线抗逆转录病毒疗法 (ART) 的有效性. 非核酸逆转录酶抑制剂耐药性普遍存在,特别是在两个地区,需要转向NRTI节省疗法.

科学领域:

病毒学和传染病学.
公共卫生和流行病学
抗微生物耐药性抗微生物耐药性

背景情况:

一线抗逆转录病毒疗法 (ART) 的有效性可能会受到先前存在的HIV抗药性 (HIVDR) 的损害.
了解HIV-1治疗前耐药性 (PDR) 模式对于有效的HIV管理策略至关重要.
在HIVDR的区域差异可能会影响公共卫生干预和治疗指南.

研究的目的:

为了描述喀麦隆的HIV-1 PDR模式.
评估病毒基因对PDR的影响.
评估PDR对一线ART治疗方案的方案影响.

主要方法:

从2014年到2019年在喀麦隆进行的PDR的哨兵监视.
对HIV-1蛋白酶和逆转录酶基因的测序.
使用斯坦福大学HIVdb.v.9.4的HIVDR解释,分析了379个序列.

主要成果:

全国PDR率为15.0%,区域差异很大 (p = 0.03).
对非核逆转录酶抑制剂 (NNRTIs) 观察到的最高PDR为12.4%,对efavirenz/nevirapine (EFV/NVP) 耐药性为7.9%.
两个地区 (远北和东部) 超过了EFV/NVP PDR的10%关键值;TDF-3TC-DTG疗法与TDF-3TC-EFV (92%) 相比,显示出更高的预测效率 (98.4%).

结论:

喀麦隆的高PDR率,无论HIV-1遗传多样性如何,都会影响基于EFV/NVP的第一线ART的疗效.
特定地区显示EFV/NVP阻力处于关键水平,这带来了重大程序性挑战.
支持紧急过渡到节省NNRTI的ART疗法,TDF-3TC-DTG证明了最佳的程序有效性.

关键词:

喀麦隆 - 喀麦隆 - 喀麦隆艾滋病病毒-1 艾滋病病毒-1 一线治疗方案的第一线治疗方案.遗传多样性遗传多样性在治疗前,耐药性药物耐药性.

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