Jessica S Glenn, Aisleen Bennett, Nicola Mackie, Hermione Lyall, Sarah Fidler, Graham Taylor, Caroline Foster
{"title":"围产期HIV-1耐药的累积流行。","authors":"Jessica S Glenn, Aisleen Bennett, Nicola Mackie, Hermione Lyall, Sarah Fidler, Graham Taylor, Caroline Foster","doi":"10.1097/QAD.0000000000004202","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To describe acquired drug resistance mutations (DRMs) amongst children and adults with perinatal HIV stratified by age.</p><p><strong>Design: </strong>Retrospective observational cohort study.</p><p><strong>Methods: </strong>Data on demographics, antiretroviral therapy (ART), viral load (VL), CD4 count and lifetime cumulative acquired DRMs was collected and disaggregated by birth era; pre and post 2000; 0-24 and ≥ 25 years (n 113 vs 167).</p><p><strong>Results: </strong>280 individuals (median age 26 years, interquartile range 21,30), 235 (84%) Black ethnicity, 160 (57%) female, with median ART exposure 17 years. 99.6% currently on ART, 205 (73%) integrase strand transfer inhibitor (INSTI) regimens, with 252 (90%) VL<200 copies/ml. 121/280 (43%) acquired resistance to ≥ one ART class (37% 0-24 versus 47% ≥ 25 years), 69/280 (25%) ≥ two (14% v 32%), and 13/280 (4.6%) ≥ three class; 11/13 (85%) aged ≥ 25 years. DRMs by ART class; 104/280 (37%), non-nucleoside reverse transcriptase inhibitor (NNRTI), 78 (28%) nucleoside reverse transcriptase inhibitor (NRTI), 15 (5%) protease inhibitor and 4 (1%) INSTI. Uni/multivariate analysis; DRM acquisition was significantly associated with >2 anchor class exposure (p = 0.000), prior AIDS diagnosis (p = 0.001, 0.085) and early mono/dual NRTI exposure (p = 0.000, 0.029).</p><p><strong>Conclusion: </strong>Despite improved ART efficacy, DRMs limit treatment options, including to long-acting injectable therapies with one third having NNRTI-DRMs. Outcomes for second-generation INSTIs are promising with low rates of resistance but require continued monitoring. Whilst multi-drug resistance rates are lower in those born post-2000, over a third already have DRMs, highlighting the ongoing need for patient-centred approaches addressing adherence and novel ART class development.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The cumulative prevalence of HIV-1 drug resistance in perinatal HIV.\",\"authors\":\"Jessica S Glenn, Aisleen Bennett, Nicola Mackie, Hermione Lyall, Sarah Fidler, Graham Taylor, Caroline Foster\",\"doi\":\"10.1097/QAD.0000000000004202\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To describe acquired drug resistance mutations (DRMs) amongst children and adults with perinatal HIV stratified by age.</p><p><strong>Design: </strong>Retrospective observational cohort study.</p><p><strong>Methods: </strong>Data on demographics, antiretroviral therapy (ART), viral load (VL), CD4 count and lifetime cumulative acquired DRMs was collected and disaggregated by birth era; pre and post 2000; 0-24 and ≥ 25 years (n 113 vs 167).</p><p><strong>Results: </strong>280 individuals (median age 26 years, interquartile range 21,30), 235 (84%) Black ethnicity, 160 (57%) female, with median ART exposure 17 years. 99.6% currently on ART, 205 (73%) integrase strand transfer inhibitor (INSTI) regimens, with 252 (90%) VL<200 copies/ml. 121/280 (43%) acquired resistance to ≥ one ART class (37% 0-24 versus 47% ≥ 25 years), 69/280 (25%) ≥ two (14% v 32%), and 13/280 (4.6%) ≥ three class; 11/13 (85%) aged ≥ 25 years. DRMs by ART class; 104/280 (37%), non-nucleoside reverse transcriptase inhibitor (NNRTI), 78 (28%) nucleoside reverse transcriptase inhibitor (NRTI), 15 (5%) protease inhibitor and 4 (1%) INSTI. Uni/multivariate analysis; DRM acquisition was significantly associated with >2 anchor class exposure (p = 0.000), prior AIDS diagnosis (p = 0.001, 0.085) and early mono/dual NRTI exposure (p = 0.000, 0.029).</p><p><strong>Conclusion: </strong>Despite improved ART efficacy, DRMs limit treatment options, including to long-acting injectable therapies with one third having NNRTI-DRMs. Outcomes for second-generation INSTIs are promising with low rates of resistance but require continued monitoring. Whilst multi-drug resistance rates are lower in those born post-2000, over a third already have DRMs, highlighting the ongoing need for patient-centred approaches addressing adherence and novel ART class development.</p>\",\"PeriodicalId\":7502,\"journal\":{\"name\":\"AIDS\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2025-04-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"AIDS\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/QAD.0000000000004202\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"AIDS","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/QAD.0000000000004202","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
The cumulative prevalence of HIV-1 drug resistance in perinatal HIV.
Objective: To describe acquired drug resistance mutations (DRMs) amongst children and adults with perinatal HIV stratified by age.
Design: Retrospective observational cohort study.
Methods: Data on demographics, antiretroviral therapy (ART), viral load (VL), CD4 count and lifetime cumulative acquired DRMs was collected and disaggregated by birth era; pre and post 2000; 0-24 and ≥ 25 years (n 113 vs 167).
Results: 280 individuals (median age 26 years, interquartile range 21,30), 235 (84%) Black ethnicity, 160 (57%) female, with median ART exposure 17 years. 99.6% currently on ART, 205 (73%) integrase strand transfer inhibitor (INSTI) regimens, with 252 (90%) VL<200 copies/ml. 121/280 (43%) acquired resistance to ≥ one ART class (37% 0-24 versus 47% ≥ 25 years), 69/280 (25%) ≥ two (14% v 32%), and 13/280 (4.6%) ≥ three class; 11/13 (85%) aged ≥ 25 years. DRMs by ART class; 104/280 (37%), non-nucleoside reverse transcriptase inhibitor (NNRTI), 78 (28%) nucleoside reverse transcriptase inhibitor (NRTI), 15 (5%) protease inhibitor and 4 (1%) INSTI. Uni/multivariate analysis; DRM acquisition was significantly associated with >2 anchor class exposure (p = 0.000), prior AIDS diagnosis (p = 0.001, 0.085) and early mono/dual NRTI exposure (p = 0.000, 0.029).
Conclusion: Despite improved ART efficacy, DRMs limit treatment options, including to long-acting injectable therapies with one third having NNRTI-DRMs. Outcomes for second-generation INSTIs are promising with low rates of resistance but require continued monitoring. Whilst multi-drug resistance rates are lower in those born post-2000, over a third already have DRMs, highlighting the ongoing need for patient-centred approaches addressing adherence and novel ART class development.
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