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首页> 外文期刊>AIDS >Continued correspondence 'Will ART rollout in Africa drive an epidemic of drug-resistant HIV?'.
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Continued correspondence 'Will ART rollout in Africa drive an epidemic of drug-resistant HIV?'.

机译：续函“在非洲开展抗病毒治疗会引发耐药性艾滋病流行吗？”。

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We were interested to read the comments by Blower et al. on our recent correspondence . We agree that combination antiretroviral therapy (ART) has been a huge success in developed countries, and the spread of resistance has been slowed compared with monotherapy. Treatment is guided by close clinical monitoring of patients, and switches in drug regimen(s) are driven by virologies] rebound, adverse drug reactions or when resistance mutations are detected. Blower et al. acknowledged that their 'central conclusion is based upon an extensive review of the literature of the experiences with ART in Europe and North America', and we are less confident that these observations can be extended to African settings. Here, most deployment will occur without close clinical monitoring, and changes in treatment regimens will be based on clinical indicators of failure (such as AIDS-defining secondary infections) rather than viral load or the detection of resistance mutations. Consequently, a large number of patients with highly viraemic resistant infections may be sexually active. Problems with infrastructure may interrupt drug supplies, and we can easily envisage a significant black market of antiretroviral drugs, both factors contributing to potential widespread non-adherence to ART regimens and the use of monotherapies on a casual ad hoc basis. Furthermore, the vast majority of data on HIV-1 drug resistance derives from studies of subtype B viruses, representing the major male homosexual epidemics in north America and Europe. This subtype represents less than 5% of global HIV-1, with subtype C representing over 50%, and it remains unclear whether the genetic barriers to resistance are identical in different subtypes , We therefore urge caution against over-complacency about the transmission of resistance during the roll-out phase. If treatment 'failure' pushes resistance to even a 'low' level of 1-2% it may create the conditions ideal for the rapid expansion of resistance once ART scale-up occurs. Initial results suggest resistance will arise relatively rapidly: a recent trial in Uganda and Zimbabwe using World Health Organization standard therapies and no viral load or resistance mutation monitoring found that at least 18 out of 300 recruits (i.e. > 6%) had 'key resistance mutations in reverse transcriptase' 24 weeks after starting therapy.
机译：我们有兴趣阅读Blower等人的评论。根据我们最近的通信。我们同意，抗逆转录病毒疗法联合治疗（ART）在发达国家取得了巨大的成功，与单药治疗相比，耐药性的传播有所减缓。治疗应通过对患者进行严密的临床监测来指导，药物方案的转换受病毒学反弹，药物不良反应或检测到耐药性突变的驱动。鼓风机等。承认他们的“中心结论是基于对欧洲和北美抗逆转录病毒治疗经验文献的广泛回顾”，我们对将这些观察结果推广到非洲环境的信心不足。在这里，大多数部署将在没有密切临床监测的情况下发生，治疗方案的改变将基于失败的临床指标（例如定义艾滋病的继发感染），而不是病毒载量或耐药性突变的检测。因此，许多具有高度抗病毒性感染的患者可能具有性活动能力。基础设施的问题可能会中断药物供应，我们可以轻松地设想到大量的抗逆转录病毒药物黑市，这两个因素都可能导致广泛不服从ART疗法，并在临时性的基础上使用单一疗法。此外，关于HIV-1耐药性的绝大多数数据来自B型病毒的研究，代表了北美和欧洲主要的男性同性恋流行病。该亚型占全球HIV-1的比例不到5％，而C亚型占50％以上，目前尚不清楚在不同亚型中抗药性的遗传障碍是否相同，因此，我们强烈建议不要过度抵抗抗药性的传播在推出阶段。如果治疗“失败”甚至将耐药性推高至1-2％的“低”水平，则可能会在ART放大后为迅速扩大耐药性创造理想条件。初步结果表明耐药性将相对较快地出现：最近在乌干达和津巴布韦进行的一项使用世界卫生组织标准疗法的试验且未进行病毒载量或耐药性突变监测，发现300名新兵中至少有18名（即6％）有“关键耐药性突变”开始治疗后24周逆转录酶逆转录酶。

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