在国际围产期虚拟诊所的新兴整合酶耐药性
Ayolola Eni-Olotu1, Nicola E Mackie2, Jessica Glenn1
1Imperial College.
AIDS (London, England)
|October 29, 2024
概括
新兴整合酶抑制剂药物耐药性突变 (INSTI-DRMs) 在患有围产期获得的艾滋病毒 (CAWHIV) 的儿童和青少年中被发现,并被转移到虚拟诊所. 这些INSTI-DRM主要观察到来自低收入和中等收入国家的高度治疗经验的个体.
科学领域:
- 病毒学和传染病学.
- 儿科艾滋病毒管理
- 药物耐药性研究 药物耐药性研究
背景情况:
- 整合酶链转移抑制剂 (INSTIs) 是现代抗逆转录病毒治疗 (ART) 艾滋病毒的基石.
- 药物耐药性突变 (DRM) 的出现可能会损害治疗的有效性,特别是在资源有限的环境中.
- 了解患有围产期艾滋病毒 (CAWHIV) 的儿童和青少年的INSTI-DRM对于优化全球治疗策略至关重要.
研究的目的:
- 为了确定CAWHIV中新出现的整合酶药物耐药性突变 (INSTI-DRMs) 的患病率,请参考一个围产期虚拟诊所 (PVC).
- 描述CAWHIV与INSTI-DRMs的临床和人口特征.
- 为了为复杂的HIV病例与病毒学失败的治疗建议提供信息.
主要方法:
- 在2018年10月至2024年1月期间,对114名CAWHIV病毒学失败的回顾性队列研究.
- 使用斯坦福艾滋病毒药物耐药性数据库对抗性突变的分析.
- 收集的数据包括ART病史,病毒载量,CD4+细胞计数和并发症.
主要成果:
- 在具有可用的抗性序列的103个病例中,19个 (31%) 经过先前的INSTI暴露 (59%) 后表现出INSTI-DRMs.
- 患有INSTI-DRMs的个体往往具有高度治疗经验 (中位数为3次先前治疗方案),主要来自低收入/中等收入国家 (LMIC) (65%).
- 新出现的INSTI-DRMs发生在第一线 (2/19) 和第二线+ART (17/19) 上,需要复杂的救援方案.
结论:
- 新兴的INSTI耐药性是高度治疗经验丰富的CAWHIV中越来越令人担忧的,特别是来自LMIC的那些人.
- 这些发现强调了全球需要改善有效的救援疗法,包括增强型蛋白酶抑制剂和新型药物类别.
- 开发适合儿童的新型抗逆转录病毒药物配方对于体重小于35公斤的儿童至关重要.
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