title: The impacts of current antiretroviral therapy regimens on Chinese AIDS patients and their implications for HIV-1 drug resistance mutation.
abstract: This study sought to investigate the impacts of the antiretroviral (ARV) therapy regimens currently used in Chinese HIV-1-infected individuals. Seven hundred eighteen ARV-treated and treatment-naive HIV-1-infected individuals living in seven provinces were enrolled in 2005 by a multistage sampling approach according to a national cross-sectional survey program on HIV-1 drug resistance. All patients were investigated clinically, and CD4+ T cell counts and HIV-1 viral loads were measured while genotyping for drug resistance was determined by a home brew nested PCR. Viral inhibition in ARV-treated individuals was higher than that in ARV treatment-naive individuals. The overall prevalence of drug-resistant mutations was 37.8%. Higher frequencies of mutations in ARV-treated and drug withdrawal groups were found than in the ARV treatment-naive group (P<0.01). Of the four regimens currently used, the D4T/3TC/NVP regimen showed a higher-level viral inhibition. No statistical significance was found among the four regimens in drug-resistant mutations. The rate of resistance-associated mutations to non-nucleotide reverse transcriptase inhibitors (NNRTIs) was higher than that to nucleotide reverse transcriptase inhibitors (NRTIs) (P<0.01). The most common mutations conferring resistance to NNRTIs were K103N, Y181C and G190A, representing 56.5, 30.4 and 14.5%, respectively. Furthermore, higher viral inhibition and a lower rate of drug-resistant mutations were achieved in the good compliance group. This study revealed an efficient viral inhibition achieved with the current first-line regimens in China. Most of these regimens could rapidly result in emergence of drug-resistant mutations, suggesting that a second-line ARV therapy is urgently needed and that the compliance with treatment must be emphasized during long-term treatment.
authors.affiliation: Key Laboratory of Immunology of AIDS, Ministry of Health, The First Hospital, China Medical University, Shenyang, P. R. China.
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.forename: Xiao-Xu
authors.initials: XX
authors.lastname: Han
authors.forename: Wei-Guo
authors.initials: WG
authors.lastname: Cui
authors.forename: Man-Hong
authors.initials: MH
authors.lastname: Jia
authors.forename: Xiang-Dong
authors.initials: XD
authors.lastname: Meng
authors.forename: Ai-Hua
authors.initials: AH
authors.lastname: Xing
authors.forename: Yu-Hua
authors.initials: YH
authors.lastname: Wu
authors.forename: Ying-Yuan
authors.initials: YY
authors.lastname: Yang
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Lu
authors.forename: Qing-Hai
authors.initials: QH
authors.lastname: Hu
authors.forename: Di
authors.initials: D
authors.lastname: Dai
authors.forename: Zi-Ning
authors.initials: ZN
authors.lastname: Zhang
authors.forename: Hong
authors.initials: H
authors.lastname: Shang
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D024882:Drug Resistance, Viral / Q000235:genetics*; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D015497:HIV-1 / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000187:drug effects*; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors