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在乌干达扩大抗逆转录病毒疗法期间的HIV耐药性,2012-19:基于人口的纵向研究

Michael A Martin¹, Steven James Reynolds², Brian T Foley³

¹Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

The Lancet. Microbe

|November 30, 2025

概括

尽管非核酸逆转录酶抑制剂 (NNRTI) 耐药性增加,但由于抗逆转录病毒治疗 (ART) 摄入量增加,艾滋病毒药物耐药性病毒病的总体减少. 高的ART覆盖率对于减少耐药HIV传播至关重要.

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:

在撒哈拉以南非洲地区,抗逆转录病毒疗法 (ART) 的使用越来越多,这引发了人们对耐药性的担忧.
对艾滋病毒药物耐药性模式的ART扩张对人口层面的影响需要量化.

研究的目的:

估计艾滋病毒耐药性和耐药性转移突变的纵向流行率.
评估ART扩展对乌干达南部艾滋病毒耐药性的影响.

主要方法:

利用了乌干达的Rakai社区队列研究 (RCCS) 的数据.
分析了来自五轮调查 (2011-2020) 的调查,艾滋病毒病毒载量和深度测序数据.
对非核酸逆转录酶抑制剂 (NNRTIs),核酸逆转录酶抑制剂 (NRTIs),蛋白酶抑制剂和多类耐药性的估计人口患病率.

主要成果:

总体而言,在2012年至2017年期间,抗药性HIV病毒病的总体流行率下降了.
在治疗前的HIV患者中,非核糖逆转录酶抑制剂 (NNRTI) 耐药性从4.86%增加到9.61%.
在经过治疗的个体中,耐药性更高;常见的突变包括rtK103N和rtM184V.

结论:

增加ART摄入量和病毒抑制导致总体抗药性HIV病毒血症的减少.
高的ART覆盖率对于减少耐药HIV的传播至关重要.
在病毒性个体中对第一线ART成分的耐药性突变的高患病率是令人担忧的.

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