HIV-1耐药突变的研究进展

Research progress of HIV-1 drug resistance mutations

至2015年止,全球约有1 700万HIV/AIDS病例得到抗逆转录病毒治疗,使HIV-1死亡率和发病率迅速下降。随着抗逆转录病毒治疗向所有感染HIV者全面推进,HIV耐药突变问题对长期治疗也构成了威胁,并对全球2030年消除艾滋病这一重要公共卫生战略产生了负面影响。本综述试图从不同的经济和地理环境出发,从个体和群体水平上阐述了常用的抗逆转录病毒药物的遗传屏障、交互耐药程度、耐药突变的流行病学和耐药管理;同时本文汇总了高、中低两类国家的可传播性耐药(TDR)和获得性耐药(ADR)的流行方式,分析了两类具有重要的公共卫生意义HIV耐药突变问题,即治疗前耐药和暴露前预防性服药的耐药。此外,鉴于有效地对不同类国家的HIV病例的治疗和管理,分别分析了基因型耐药性检测和治疗实践方面的关联,这些内容对我国的艾滋病防治也具有一定的参考作用。

By the end of 2015,all over the world there were around 17 million HIV/AIDS cases received antiretroviral therapy,the HIV-1 morbidity and mortality decreased rapidly.With antiretroviral treatment to all HIV infected persons,HIV resistance mutation is also a threat to the long-term treatment and also,had a negative impact on the important public health strategy of the global elimination in 2030.This review attempts to proceed from different economic and geographical environment,describing genetic barrier of commonly used antiretroviral drugs,the degree of their cross-reactions,and the epidemiology and management of drug-resistant mutations from the individual and group levels.The paper also summarizes the prevalent modes of transmitted drug resistance(TDR)and acquired drug resistance(ADR)in both high-income and low-and middle-income countries(LMICs),and analyze the two kind problems of public health significance to HIV resistant mutations,i.e.pretreatment resistance(PDR)and preexposure prophylaxis(PrEP).In addition,in view of effectivel HIV cases of treatment and management in different countries,this paper also analyzes the genotypic resistance testing and treatment practices related to AIDS prevention and control.The content has a certain reference function to our country.