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乌干达治疗扩大期间艾滋病毒耐药性的人口动态:基于人口的纵向研究

Michael A Martin¹, Steven James Reynolds^2,3,4, Brian T Foley⁵

¹Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.

medRxiv : the preprint server for health sciences

|October 17, 2024

概括

治疗前的HIV耐药性,特别是NNRTI耐药性,在乌干达增加,但由于成功扩大ART,总体人口耐药性下降. 经过治疗的个体现在比治疗前的病例对艾滋病毒耐药性的贡献更大.

科学领域:

流行病学流行病学
病毒学病毒学
公共卫生公共卫生

背景情况:

临床研究表明,在非洲的抗逆转录病毒治疗 (ART) 扩展期间,治疗前艾滋病毒耐药性增加.
在ART扩张期间,关于艾滋病毒药物耐药性趋势的代表性人口级数据仍然有限.

研究的目的:

在乌干达的ART扩张期间估计人口级药物耐药性趋势.
分析HIV-1亚型中特定耐药性突变的流行率.

主要方法:

分析乌干达南部Rakai社区队列研究 (2012-2019) 的数据.
来自艾滋病毒感染者 (PLHIV) 的HIV-1病毒样本的深度测序,以预测耐药性.
强大的log-Poisson回归以估计特定类抗性和抗性转移替代物的种群流行率.

主要成果:

在治疗前的病毒性PLHIV中,NNRTI耐药性的患病率在2012年至2017年期间翻了一番,达到9.61%.
由于治疗覆盖率增加和病毒抑制,治疗前NRTI和NRTI耐药性的总人口患病率显著下降 (p<0.002).
到2019年,经过治疗的PLHIV的耐药性超过了治疗前PLHIV的耐药性,NRTI耐药性为0.54%,NRTI耐药性为0.42%.

结论:

尽管在治疗前的PLHIV中NNRTI耐药性增加,但由于ART扩展,整体人群耐药性下降.
经过治疗的PLHIV现在是NNRTI和NRTI耐药性的主要贡献者.
在病毒性PLHIV中对当前一线ART疗法产生耐药性突变的高患病率令人担忧.

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