HIV耐药的现状、挑战与应对

Current status,challenge and response to HIV drug resistance

近年来,全球HIV耐药毒株发生和流行的形势发生了显著变化,在高收入国家呈稳定或下降趋势,而在广大中低收入国家仍呈上升趋势。预计2030年全球将有3300万人终生接受抗病毒治疗,极易出现治疗疲劳,保持良好的依从性是现实的挑战,存在由于漏服药物致使耐药毒株出现和流行的巨大风险。为了有效应对耐药,应做到:(1)加强病毒载量监测以预防耐药发生,及时发现病毒反弹,在多个耐药突变出现前改善依从性或调整治疗方案,避免耐药突变积累。(2)改进基因型耐药检测方法,建立简便的即时检测方法,最好与病毒载量即时检测试剂联合应用。(3)加强对耐药毒株流行的监测,做好治疗前耐药、获得性耐药和耐药早期预警监测。(4)研究新型防治策略的耐药问题,包括暴露前后预防和急性期治疗的耐药发生规律。(5)建立可有效减少耐药的新型防治模式,优化治疗服务,确保药物供应不中断,最大限度保持治疗减少脱失,有效评估、促进和保持依从性。

The occurrence and epidemiology of drug-resistant HIV strains have been significantly changed in recent years,showing a relative stable or decline trend in high-income countries,whereas upward in low-and middle-income countries.More than 33 million patients are estimated to receive lifelong antiretroviral therapy in the year of 2030.The treatment fatigue will be inevitable.How to maintain good compliance is a challenge in practice.The occurrence and transmission of drugresistant HIV strains due to missed dose will be at considerable risk.To effectively control HIV drug resistance,the following measures should be taken:①strengthening the viral load surveillance,so as to prevent drug resistance:finding the viral rebound in time,modifying the compliance or revising the treatment regimen prior to the emergence of multiple drug resistance mutations and avoiding the accumulated mutation of drug resistance;②modifying genotype drug resistance test method:establishing convenient and immediate test methods and combining with the reagents used for real-time viral load assay;③strengthening the surveillance of drug-resistant strains and including pre-treatment drug resistance,acquired drug resistance and early warning surveillance;④clarifying the drug resistance related with novel prevention strategies,including pre-exposure prophylaxis and treatment at acute phase;⑤establishing novel treatment model minimizing drug resistance,optimizing treatment services,supplying drugs continually,maintaining the follow-ups,reducing drop-outs and effectively evaluating,promoting and maintaining the compliance.