警惕对第二代整合酶抑制剂的耐药性:HIV-1整合酶抑制剂耐药性和耐药突变的系统性元分析。

IF 4.9 2区 医学 Q1 INFECTIOUS DISEASES International Journal of Antimicrobial Agents Pub Date : 2024-08-07 DOI:10.1016/j.ijantimicag.2024.107294
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摘要

目的:评估艾滋病毒/艾滋病患者对整合酶链转移抑制剂(INSTIs),尤其是第二代 INSTIs 的耐药性和耐药突变(DRMs)的发生率,为临床合理用药提供证据:在五个数据库中进行了系统检索,以确定报告 INSTIs 耐药性原始数据的相关文献。根据异质性检验结果,采用选定的模型进行元分析、累积元分析、亚组分析和元回归分析:本次分析共纳入了 81 项研究。第一代INSTIs和第二代INSTIs治疗前耐药(PDR)的发生率分别为0.41%(95% CI:0.19%-0.70%)和0.04%(95% CI:0.00%-0.13%);获得性耐药(ADR)的发生率分别为7.60%(95% CI:3.54%-12.92%)和4.93%(95% CI:1.78%-9.36%),且ADR呈先增后减的时间趋势。亚组分析结果显示,第二代 INSTIs 的 ADR 在不同地区和经济水平之间存在差异,欧洲地区的 ADR 最高,为 12.83%(95% CI:3.24%-27.17%)。HIV患者的DRM各不相同,药物敏感性也有不同程度的降低:目前,第二代 INSTIs 的 PDR 和 DRM 发生率较低,但随着基于 DTG 的抗逆转录病毒疗法使用范围的扩大,应加强人群耐药性监测和个体基因检测,以最大限度地提高治疗效果。此外,还应关注 INSTIs 的 ADR,以便为艾滋病毒感染者提供个性化治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Beware of resistance to 2nd-generation integrase inhibitors: A systematic meta-analysis of HIV-1 integrase inhibitors resistance and drug resistance mutations

Objective

Assessing the prevalence of resistance and drug resistance mutations (DRMs) in HIV/AIDS patients towards integrase strand transfer inhibitors (INSTIs), particularly the 2nd-generation INSTIs, provides evidence for rational clinical drug use.

Methods

A systematic search was conducted on five databases to identify relevant literature reporting original data on INSTIs resistance. Meta-analyses, cumulative meta-analyses, subgroup analyses and meta-regression analyses were performed using selected models based on the results of heterogeneity tests.

Results

A total of 81 studies were included in this analysis. The prevalence of pre-treatment drug resistance (PDR) to 1st-generation INSTIs and 2nd-generation INSTIs were 0.41% (95% CI: 0.19%–0.70%) and 0.04% (95% CI: 0.00%–0.13%), respectively; and the prevalence of acquired drug resistance (ADR) were 7.60% (95% CI: 3.54%–12.92%) and 4.93% (95% CI: 1.78%–9.36%), respectively, and ADR showed an increasing and then decreasing time trend. The results of subgroup analyses showed differences in ADR to 2nd-generation INSTIs between regions and economic levels, with the highest ADR of 12.83% (95% CI: 3.24%–27.17%) in the European region. DRMs varied among HIV patients and reduced drug sensitivity to varying degrees.

Conclusion

The prevalence of PDR and DRMs in 2nd-generation INSTIs is currently low, but as the use of DTG-based ART expands, population-level drug resistance monitoring and individual-level genetic testing should be strengthened in order to maximise treatment efficacy. Additionally, attention should be paid to ADR to INSTIs to provide personalised treatments for HIV-infected patients.

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来源期刊
CiteScore
21.60
自引率
0.90%
发文量
176
审稿时长
36 days
期刊介绍: The International Journal of Antimicrobial Agents is a peer-reviewed publication offering comprehensive and current reference information on the physical, pharmacological, in vitro, and clinical properties of individual antimicrobial agents, covering antiviral, antiparasitic, antibacterial, and antifungal agents. The journal not only communicates new trends and developments through authoritative review articles but also addresses the critical issue of antimicrobial resistance, both in hospital and community settings. Published content includes solicited reviews by leading experts and high-quality original research papers in the specified fields.
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