西班牙耐多药艾滋病毒感染者的流行情况和有限的治疗方案

IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES
HIV Medicine Pub Date : 2024-04-30 DOI:10.1111/hiv.13650
Josep M. Llibre, Federico García, José Luis Blanco, Esmeralda Palmier Peláez, Álvaro Mena de Cea, Luis López Cortés, Marta Montero Alonso, Miguel Pascual Bernáldez, Melanie Schroeder, Silvia Esteban Sánchez, Felipe Rodríguez Alcántara
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引用次数: 0

摘要

目的我们的目的是确定西班牙接受抗逆转录病毒疗法(ART)并伴有多药耐药性(MDR;对三种或三种以上[或对两种或两种以上]核心抗逆转录病毒疗法类药物耐药并对一种或一种以上]核心抗逆转录病毒疗法类药物有禁忌症)和有限治疗方案(LTO)的艾滋病病毒感染者的患病率和特征。方法这是一项观察性、回顾性、多中心、横断面图表回顾研究,在西班牙的五个参考中心进行。研究对象为接受抗逆转录病毒疗法的艾滋病病毒感染者,他们都患有 MDR 和 LTO(可检测到的病毒载量 [HIV-RNA >200 copies/mL]、限制治疗的药物相互作用 [DDI],或因不耐受而无法使用一种或多种抗逆转录病毒疗法)。对患病率、人口学/临床特征和治疗方案进行了评估。结果 在 14 955 名接受筛查的 HIV 感染者中,69 人(0.46%)出现 MDR,23 人(0.15%)出现 LTO。接受分析的人群中,73.9%为男性,中位年龄为 54.0 岁;确诊为艾滋病病毒感染者的中位时间为 26.5 年,CD4+细胞计数中位数为 511.0 cells/μL。唯一与 MDR 明显相关的因素(单变量分析)是 CD4+ 细胞计数。注射吸毒是最常见的传播途径。合并症(主要是内分泌和心血管疾病;34.8%的合并症影响了艾滋病的治疗)和并发症治疗很常见。近期没有机会性感染的报告。患者曾接受过以下抗逆转录病毒疗法:核苷类似物逆转录酶抑制剂(100%)、蛋白酶抑制剂(95.6%)、非核苷类似物逆转录酶抑制剂(87.0%)和整合酶链转移抑制剂(82.6%)。结论在西班牙,MDR 和 LTOs 艾滋病毒感染者的发病率非常低,约有一半的研究对象未表现出病毒学抑制。低 CD4+ 细胞计数与 MDR 相关。这些发现可能有助于解决这些患者的影响和治疗需求,并防止 MDR HIV 的临床进展和传播。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prevalence of people living with multidrug-resistant HIV and limited treatment options in Spain

Objectives

Our aim was to determine the prevalence and characteristics of people with HIV on antiretroviral therapy (ART) with multidrug resistance (MDR; confirmed resistance to three or more [or resistance to two or more plus contraindication to one or more] core ART classes) and limited treatment options (LTOs) in Spain.

Methods

This was an observational, retrospective, multicentre, cross-sectional chart review study undertaken in five reference Spanish centres. Participants were people with HIV on ART with MDR and LTOs (detectable viral load [HIV-RNA >200 copies/mL], treatment-limiting drug–drug interaction [DDI], or intolerance precluding the use of one or more ART classes). Prevalence, demographic/clinical characteristics, and treatment options were assessed. Logistic regression analyses were used to identify MDR-associated variables.

Results

Of 14 955 screened people with HIV, 69 (0.46%) presented with MDR and 23 (0.15%) had LTOs. The population analysed was 73.9% male with a median age of 54.0 years; the median time since HIV diagnosis was 26.5 years, and median CD4+ cell count was 511.0 cells/μL. The only factor significantly associated with MDR (univariate analysis) was CD4+ cell count. Injection drug use was the most common transmission route. Comorbidities (mainly endocrine and cardiovascular disorders; 34.8% affecting HIV management) and concomitant treatments were frequent. No recent opportunistic infections were reported. Patients had been exposed to the following ART: nucleoside analogue reverse transcriptase inhibitors (100%), protease inhibitors (95.6%), non-nucleoside analogue reverse transcriptase inhibitors (87.0%), and integrase strand transfer inhibitors (82.6%). The available fully active drugs were dolutegravir (39.1%), bictegravir (30.4%), and raltegravir (21.7%).

Conclusions

The prevalence of people with HIV with MDR and LTOs in Spain is very low, with approximately half of those studied not exhibiting virological suppression. Low CD4+ cell counts were associated with MDR. These findings may help address the impact and treatment needs of these patients and prevent clinical progression and transmission of MDR HIV.

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来源期刊
HIV Medicine
HIV Medicine 医学-传染病学
CiteScore
5.10
自引率
10.00%
发文量
167
审稿时长
6-12 weeks
期刊介绍: HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.
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