初治HIV-1患者多替格拉韦耐药的传播：一项队列研究

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases Pub Date : 2025-02-12 DOI:10.1016/j.bjid.2025.104513

Jorge Francisco da Cunha Pinto , Luiza Brito Gomes , Natalia Dias Melo , Fabiana Barbosa Assumpção de Souza , Debora Viana Freitas , Sara Gonzalez Viega , Erica Ramos dos Santos Nascimento , Lidia Theodoro Boullosa , Cynthia Chester Cardoso , Amilcar Tanuri

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引用次数: 0

摘要

多替格拉韦（DTG）因其高疗效和安全性被广泛应用于一线抗逆转录病毒治疗（ART）。然而，对DTG耐药性的担忧仍然存在。本研究调查了巴西初次接受治疗的hiv -1感染者中传播的DTG耐药的流行情况和相关因素。该研究于2019年5月至2022年5月在巴西里约热内卢的一个艾滋病毒/艾滋病参考中心对150名未经治疗的HIV-1患者进行了随访。评估基线特征、病毒载量和CD4 +细胞计数。基线时对血浆样本进行基因型耐药检测，并在随访期间监测病毒载量。结果131例患者完成了研究。平均年龄37.73岁；其中男性107例，女性24例。病毒载量的中位基线为4.33 log(21,193拷贝/mm3)， CD4 +计数为342细胞/mm3，最低计数为8细胞/mm3。CD4 +计数平均增加112个细胞/mm3 (p <；0.01)。109名患者在开始抗逆转录病毒治疗3个月后达到了无法检测的病毒载量，只有8名患者在6个月后没有达到无法检测的水平（42-106拷贝/mm3）。最常见的早期不良反应是恶心（12.9%），最常见的后期不良反应是肌酐水平升高（9.1%），导致暂停或替代富马酸替诺福韦二氧吡酯（TDF）。85例患者成功分型：B亚型66例，C亚型9例，F亚型8例，CRF47_BF 2例，无耐药突变，1例辅助突变（T97A）。结论：本研究未证实在初次治疗的hiv -1感染者中传播的DTG耐药。研究结果表明，DTG仍然是一种安全有效的一线抗逆转录病毒治疗选择。然而，建议所有接受含dtg抗逆转录病毒治疗方案的患者密切监测病毒载量。此外，应对病毒学失败或CD4 +细胞计数显著下降的个体进行基因型耐药检测，并密切关注抗逆转录病毒治疗的依从性。

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Transmission of Dolutegravir resistance in treatment-naive individuals with HIV-1: A cohort study

Background

Dolutegravir (DTG) is widely used as a first-line Antiretroviral Therapy (ART) due to its high efficacy and safety. However, concerns about DTG resistance persist. This study investigated the prevalence and factors associated with transmitted DTG resistance in treatment-naive HIV-1-infected individuals in Brazil.

Methods

The study followed 150 treatment-naive HIV-1 individuals from May 2019 to May 2022 at a reference center for HIV/AIDS in Rio de Janeiro, Brazil. Baseline characteristics, viral load, and CD4 + cell counts were assessed. Genotypic resistance testing was conducted on plasma samples at baseline, and viral load was monitored during follow-up visits.

Results

One hundred and thirty-one patients completed the study. The mean age was 37.73-years; 107 were male, and 24 were female. The median baseline of viral load was 4.33 log (21,193 copies/mm³), and CD4 + count was 342 cells/mm³, with the lowest count being 8 cells/mm³. The mean CD4 + count increase was 112 cells/mm³ (p < 0.01). One hundred and nine patients achieved an undetectable viral load three months after starting ART, with only eight patients not reaching undetectable levels by six months (42‒106 copies/mm³). The most common early adverse effect was nausea (12.9 %), and the most common later effect was increased creatinine levels (9.1 %), leading to the suspension or substitution of Tenofovir Disoproxil Fumarate (TDF). Genotyping was successfully performed on 85 patients: 66 were subtype B, 9 subtype C, 8 subtype F, and two CRF47_BF, with no resistance mutations and one accessory mutation (T97A).

Conclusion

This study did not demonstrate transmitted DTG resistance among treatment-naive HIV-1-infected individuals. The findings suggest that DTG remains a safe and effective first-line ART option. However, close monitoring of viral load is recommended for all patients on DTG-containing ART regimens. Additionally, genotypic resistance testing should be performed on individuals who experience virological failure or a significant decline in CD4 + cell counts, with close attention to ART adherence.

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来源期刊

Brazilian Journal of Infectious Diseases 医学-传染病学

CiteScore

5.50

自引率

0.00%

发文量

925

审稿时长

41 days

期刊介绍： The Brazilian Journal of Infectious Diseases is the official publication of the Brazilian Society of Infectious Diseases (SBI). It aims to publish relevant articles in the broadest sense on all aspects of microbiology, infectious diseases and immune response to infectious agents. The BJID is a bimonthly publication and one of the most influential journals in its field in Brazil and Latin America with a high impact factor, since its inception it has garnered a growing share of the publishing market.