Predictors of HIV virological failure and drug resistance in Chinese patients after 48 months of antiretroviral treatment, 2008-2012: a prospective cohort study

被引：14

作者：

Kan, Wei ^{[1
]}

Teng, Tao ^{[1
]}

Liang, Shujia ^{[2
]}

Ma, Yanling ^{[3
]}

Tang, Heng ^{[4
]}

Zuohela, Tuerdi ^{[5
]}

Sun, Guoqing ^{[6
]}

He, Cui ^{[1
]}

Wall, Kristin M. ^{[7
]}

Marconi, Vincent C. ^{[8
,9
]}

Liao, Lingjie ^{[1
]}

Leng, Xuebing ^{[1
]}

Liu, Pengtao ^{[1
]}

Ruan, Yuhua ^{[1
,10
]}

Xing, Hui ^{[1
]}

Shao, Yiming ^{[1
]}

机构：

[1] Collaborat Innovat Ctr Diag & Treatment Infect Di, Div Virol & Immunol, State Key Lab Infect Dis Prevent & Control, Natl Ctr AIDS STD Control & Prevent,Chinese Ctr D, Beijing, Peoples R China

[2] Guangxi Ctr Dis Control & Prevent, Dept HIV AIDS Control & Prevent, Nanning, Peoples R China

[3] Yunnan Ctr Dis Control & Prevent, Dept HIV AIDS Control & Prevent, Kunming, Yunnan, Peoples R China

[4] Hubei Ctr Dis Control & Prevent, Dept HIV AIDS Control & Prevent, Kunming, Yunnan, Peoples R China

[5] Dept HIV AIDS Control & Prevent, Xinjiang Autonomous Region Ctr Dis Control & Prev, Urumqi, Peoples R China

[6] Henan Ctr Dis Control & Prevent, Dept HIV AIDS Control & Prevent, Zhengzhou, Henan, Peoples R China

[7] Emory Univ, Dept Epidemiol, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA

[8] Emory Univ, Dept Global Hlth, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA

[9] Emory Univ, Sch Med, Div Infect Dis, Atlanta, GA USA

[10] Chinese Ctr AIDS STD Control & Prevent, Div Virol & Immunol, Beijing, Peoples R China

来源：

BMJ OPEN | 2017年 / 7卷 / 09期

关键词：

GENDER-DIFFERENCES; FOLLOW-UP; THERAPY; RISK; SURVEILLANCE; INDIVIDUALS; ZIDOVUDINE; LAMIVUDINE; MORTALITY; INFECTION;

D O I：

10.1136/bmjopen-2017-016012

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective To explore factors associated with HIV virological failure (VF) and HIV drug resistance (HIVDR) among HIV-positive Chinese individuals 4 years after initiating first-line lamivudine-based antiretroviral treatment (ART) in 2008 at five sentinel sites. Design First-line ART initiators who were previously treatment naive were selected using consecutive ID numbers from the 2008 National Surveillance Database into a prospective cohort study. Questionnaires and blood samples were collected in 2011 and 2012 to assess the outcomes of interest: VF (defined as viral load =1000 copies/mL) and HIVDR (defined as VF with genetic drug-resistant mutations). Questionnaires and data from National Surveillance Database assessed demographics and drug adherence data. Results 536 individuals with HIV were analysed; the 4-year risk of VF was 63 (11.8%) and HIVDR was 27 (5.0%). Female participants initiating stavudine (D4T)-based regimens were more susceptible to both VF (adjusted OR (aOR)=2.5, 95% CI 1 to 6.1, p=0.04) and HIVDR (aOR=3.6, 95% CI 1 to 12.6, p=0.05) versus zidovudine-based regimens. Male participants missing doses in past month were more susceptible to both VF (aOR=2.8, 95% CI 1.1 to 7, p=0.03) and HIVDR (aOR=9.7, 95% CI 2.1 to 44.1, p<0.01). Participants of non-Han nationality were of increased risk for HIVDR (aOR from 4.8 to 12.2, p<0.05) and non-Han men were at increased risk for VF (aOR=2.9, 95% CI 1.1 to 7.3, p=0.02). All 27 participants detected with HIVDR had non-nucleoside reverse-transcriptase inhibitor mutations, 21 (77.8%) also had nucleoside reverse-transcriptase inhibitor mutations, and no protease inhibitor mutations were detected. Conclusions Our findings suggest successful treatment outcomes at 4 years for roughly 90% of patients. We suggest conducting further study on whether and when to change ART regimen for women initiated with D4T-based regimen, and reinforcing adherence counselling for men. Increased VF and HIVDR risk among non-Han minorities warrants further exploration, and ethnic minorities may be an important group to tailor adherence-focused interventions.

引用

页数：15