Lancet HIV:二线抗逆转录病毒疗法中核苷类逆转录酶抑制剂的活性预测

2017-05-09 zhangfan MedSci原创

基因型耐药检测可能无法准确预测二线抗逆转录病毒疗法中核苷类逆转录酶抑制剂的活性

一线抗逆转录病毒疗法(ART)失败后的交叉耐药性会削弱二线核苷类逆转录酶抑制剂(NRTIs)的治疗活性,但交叉耐药性对抗病毒结果的影响的证据却很有限。近日研究人员通过耐药性试验预测二线核苷类逆转录酶抑制剂的活性对于HIV患者的治疗结果的影响。

研究人员收集了在撒哈拉以南的非洲,随机试验的二线抗逆转录病毒疗法临床研究数据,有1277成人或青少年艾滋病毒感染第一线ART失败患者参与研究,随机接受增强型蛋白酶抑制剂(利托那韦+洛匹那韦)联合2或3种NRTIs(临床医师选择不进行耐药性试验)或雷特格韦或单一的蛋白酶抑制剂治疗,持续96周。对蛋白酶组和NRTI组患者进行基因型耐药性测试并计算2线NRTIs的活性。每12 - 16周测量患者的病毒载量。

研究中获得了92%患者的基线基因型,其中预测发现176名(89%)的患者在第144周对蛋白酶抑制剂耐药但对NRTIs不耐药,而事实上单一的蛋白酶抑制剂组耐药患者比例为61%,雷特格韦耐药比例为81%。在NRTIs组,有85%对一种NRTI耐药,有77%对2-3种NRTI耐药。总体上,NRTI活性预测对病毒载量抑制关联性较差(p=0.0004)。

研究认为,基因型耐药检测可能无法准确预测二线抗逆转录病毒疗法中核苷类逆转录酶抑制剂的活性。

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    2017-08-29 hxj0117
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    2017-06-11 mjldent
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    2018-03-28 jklm09
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    2018-02-18 howi
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    2017-05-09 往日如昨

    学习了谢谢分享

    0

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    2017-05-09 dhzzm

    学习了分享了

    0

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