在大量使用 PrEP 的环境中,新近确诊的 HIV 阳性男男性行为者的 HIV 耐药性发生率较低。

IF 4.6 1区 医学 Q2 IMMUNOLOGY
Jonathan M King, Francesca Di Giallonardo, Ansari Shaik, Skye McGregor, Julie Yuek Kee Yeung, Tharshini Sivaruban, Frederick J Lee, Philip Cunningham, Dominic E Dwyer, Steven J Nigro, Andrew E Grulich, Anthony D Kelleher
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引用次数: 0

摘要

导言:新南威尔士州(NSW)是世界上艾滋病暴露前预防疗法(PrEP)使用率最高的地区之一。艾滋病毒传播率的大幅下降,尤其是在澳大利亚出生的男同性恋者和双性恋者中的传播率大幅下降,都归功于这种预防措施。有人担心,在大量使用 PrEP 的情况下,可能会出现替诺福韦(TFV)和 XTC(拉米夫定/恩曲他滨)的抗药性。这种耐药性的出现也会增加艾滋病病毒感染者(PLHIV)的治疗失败和相关临床结果。尽管在临床环境中与 PrEP 使用相关的核苷类逆转录酶抑制剂(NRTI)耐药性水平较低,但很少有公开发表的研究描述在大量使用 PrEP 的环境中新诊断出的 HIV 感染者中 NRTI 耐药性的流行情况:我们利用与新南威尔士州 2015 年 1 月 1 日至 2021 年 12 月 31 日期间确诊的艾滋病病毒感染者通知记录相关联的艾滋病抗逆转录病毒药物耐药性数据,描述了 TFV 和 XTC 耐药性的趋势。耐药性是通过斯坦福艾滋病耐药性基因型耐药性解释系统确定的。为了重点关注传播耐药性,我们使用艾滋病毒确诊后不到 3 个月的序列生成了耐药性流行率估计值。这些估计值按相对于诊断日期的测序时间、测序年份、出生地、可能感染 HIV 的地点以及诊断时 HIV 的阶段进行了分层:结果:在与诊断后不到 3 个月测序的 HIV 基因组相关的 1119 例诊断中,XTC 耐药率总体为 1.3%。2015 年至 2021 年期间,XTC 耐药率在 0.5% 至 2.9% 之间波动,2021 年为 1.0%。在研究期间,所分析的序列中均未发现 TFV 耐药性。在新感染艾滋病毒(确诊前 12 个月内有感染艾滋病毒的证据;2.9%,p = 0.008)的人群中,XTC 耐药率较高:在澳大利亚的这一环境中,新诊断出的艾滋病毒感染者中 TFV 和 XTC 耐药率仍然很低。我们的研究结果为在高收入地区安全推广 PrEP 提供了进一步的证据,同时不会影响对艾滋病感染者的治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Low HIV drug resistance prevalence among recently diagnosed HIV-positive men who have sex with men in a setting of high PrEP use

Low HIV drug resistance prevalence among recently diagnosed HIV-positive men who have sex with men in a setting of high PrEP use

Introduction

New South Wales (NSW) has one of the world's highest uptake rates of HIV pre-exposure prophylaxis (PrEP). This uptake has been credited with sharp declines in HIV transmission, particularly among Australian-born gay and bisexual men. Concerns have been raised around the potential for the emergence of tenofovir (TFV) and XTC (lamivudine/emtricitabine) resistance in settings of high PrEP use. Such an emergence could also increase treatment failure and associated clinical outcomes among people living with HIV (PLHIV). Despite low levels of nucleoside reverse-transcriptase inhibitor (NRTI) resistance relating to PrEP use in clinical settings, there are few published studies describing the prevalence of NRTI resistance among people newly diagnosed with HIV in a setting of high PrEP use.

Methods

Using HIV antiretroviral drug resistance data linked to NSW HIV notifications records of people diagnosed from 1 January 2015 to 31 December 2021 and with HIV attributed to male-to-male sex, we described trends in TFV and XTC resistance. Resistance was identified using the Stanford HIV Drug Resistance genotypic resistance interpretation system. To focus on transmitted drug resistance, resistance prevalence estimates were generated using sequences taken less than 3 months post-HIV diagnosis. These estimates were stratified by timing of sequencing relative to the date of diagnosis, year of sequencing, birthplace, likely place of HIV acquisition, and stage of HIV at diagnosis.

Results

Among 1119 diagnoses linked to HIV genomes sequenced less than 3 months following diagnosis, overall XTC resistance prevalence was 1.3%. Between 2015 and 2021, XTC resistance fluctuated between 0.5% to 2.9% and was 1.0% in 2021. No TFV resistance was found over the study period in any of the sequences analysed. Higher XTC resistance prevalence was observed among people with newly acquired HIV (evidence of HIV acquisition in the 12 months prior to diagnosis; 2.9%, p = 0.008).

Conclusions

In this Australian setting, TFV and XTC resistance prevalence in new HIV diagnoses remained low. Our findings offer further evidence for the safe scale-up of PrEP in high-income settings, without jeopardizing the treatment of those living with HIV.

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来源期刊
Journal of the International AIDS Society
Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES
CiteScore
8.60
自引率
10.00%
发文量
186
审稿时长
>12 weeks
期刊介绍: The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.
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