加拿大不列颠哥伦比亚省低病毒载量标本中出现或发展的HIV耐药性的临床和社会人口学相关性

IF 4 3区医学 Q2 VIROLOGY

Journal of Clinical Virology Pub Date : 2025-06-01 DOI:10.1016/j.jcv.2025.105807

Hanwei Sudderuddin , Charlotte Johanna Beelen , Jenny Li , Wendy Zhang , Melanie C.M. Murray , Viviane D. Lima , Julio S.G. Montaner , Chanson J. Brumme

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引用次数: 0

摘要

背景/方法治疗指南建议在病毒学失败时进行基因型HIV耐药检测（DRT），通常用于检测血浆病毒载量（pVL） >；1000 HIV RNA c/mL。在某些情况下，DRT可以在低病毒载量（LVL）样品（pVL为50-250 c/mL）上进行；然而，这种检测是资源密集型的，其临床效益尚不清楚。因此，我们利用一个综合性的省级HIV蛋白酶-逆转录酶和整合酶序列数据库，调查了LVL样本中出现耐药性的频率和相关因素。结果1999年至2022年，不列颠哥伦比亚省共进行了43,979例蛋白酶rt DRTs，其中LVL样本为2970例（6.8%）。1575个（53.0%）LVL样品检测成功，而pVL 250-999和pVL≥1000 c/mL的样品分别为81.4%和94.4% (p <；0.001)。与先前从pVL和gt样本中收集的基因型进行比较；从1423例LVL DRTs中共鉴定出104例（7.3%）新的或正在发展的耐药病例。其中，49.5%、42.9%和22.9%分别表现出新的核苷逆转录酶、非核苷逆转录酶和蛋白酶抗性。在2008年至2022年期间进行的9309例整合酶drt中，仅观察到4例（1.2%）新的或进化的整合酶耐药病例。多变量分析确定了与出现耐药性显著相关的临床/社会人口因素，包括drt、历史累积耐药性和基于nnrti的抗逆转录病毒治疗之间的时间间隔。结论在低病毒载量标本中，出现耐药性或进化耐药性的情况并不多见。鉴于其资源密集型性质，通常不需要对低病毒载量标本进行耐药性检测。

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Clinical and sociodemographic correlates of emergent or evolving HIV drug resistance in low viral load specimens in British Columbia, Canada

Background/methods

Treatment guidelines recommend genotypic HIV drug resistance testing (DRT) at virologic failure, typically for plasma viral loads (pVL) > 1000 HIV RNA c/mL. In some settings, DRT can be performed on low viral load (LVL) samples (pVL of 50–250 c/mL); however, such testing is resource-intensive and its clinical benefit is unclear. Therefore, we investigated the frequency and factors associated with emergent resistance in LVL samples using a comprehensive, provincial database of HIV Protease-Reverse Transcriptase and Integrase sequences.

Results

A total of 43,979 Protease-RT DRTs were performed in British Columbia between 1999 and 2022, of which 2970 (6.8 %) were on LVL samples. Testing was successful for 1575 (53.0 %) LVL samples compared to 81.4 % and 94.4 % of samples with pVL 250–999 and pVL ≥ 1000 c/mL, respectively (p < 0.001). Compared to prior genotypes collected from samples with pVL > 250 c/mL, a total of 104 (7.3 %) cases of new or evolving drug resistance were identified from 1423 LVL DRTs. Of these, 49.5 %, 42.9 % and 22.9 % exhibited new Nucleoside Reverse Transcriptase, Non-Nucleoside Reverse Transcriptase and Protease resistance, respectively. Of 9309 Integrase DRTs performed between 2008 and 2022, only 4 (1.2 %) cases of new or evolving integrase resistance were observed. Multivariable analyses identified clinical/sociodemographic factors significantly associated with emergent resistance, including time elapsed between DRTs, historic cumulative resistance and NNRTI-based antiretroviral therapy.

Conclusions

Emergent or evolving resistance is identified infrequently in low viral load specimens. Given its resource-intensive nature, resistance testing of low viral load specimens may not be generally warranted.

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来源期刊

Journal of Clinical Virology 医学-病毒学

CiteScore

22.70

自引率

1.10%

发文量

149

审稿时长

24 days

期刊介绍： The Journal of Clinical Virology, an esteemed international publication, serves as the official journal for both the Pan American Society for Clinical Virology and The European Society for Clinical Virology. Dedicated to advancing the understanding of human virology in clinical settings, the Journal of Clinical Virology focuses on disseminating research papers and reviews pertaining to the clinical aspects of virology. Its scope encompasses articles discussing diagnostic methodologies and virus-induced clinical conditions, with an emphasis on practicality and relevance to clinical practice. The journal publishes on topics that include: • new diagnostic technologies • nucleic acid amplification and serologic testing • targeted and metagenomic next-generation sequencing • emerging pandemic viral threats • respiratory viruses • transplant viruses • chronic viral infections • cancer-associated viruses • gastrointestinal viruses • central nervous system viruses • one health (excludes animal health)