A carregar...
Publicação
Estudo de resistências transmitidas e adquiridas a antirretrovirais em indivíduos com diagnóstico tardio de infeção por VIH-1
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 2.1 MB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
Introdução: A incidência de infeção por VIH em Portugal é das mais altas entre os países da União Europeia. O diagnóstico atempado e o acompanhamento regular nos centros de tratamento são importantes para o prognóstico do indivíduo portador e na prevenção de novas infeções. Em 55,8% dos casos diagnosticados em Portugal, verificam-se critérios de apresentação tardia (contagens de células CD4+ inferiores a 350/mm3 ou doença definidora de SIDA).
Este trabalho tem como objetivo determinar a prevalência das resistências transmitidas aos antirretrovirais (TDR) e resistências adquiridas aos antirretrovirais (ADR) numa população de indivíduos infetados por VIH-1 observada no Serviço de Doenças Infecciosas do Hospital Egas Moniz, com diagnóstico tardio (LP) ou não tardio
(NLP).
Métodos: Foi efetuada genotipagem das sequências de VIH-1 em amostras de 539 indivíduos coletadas entre 2001 e 2017 e estas foram categorizadas em dois grupos (LP e NLP), nos quais foram avaliadas a prevalência e os padrões das mutações de resistência antes do tratamento com antirretrovirais (TDR), de acordo com a lista de referência (2009) preconizada pela OMS.
A prevalência e os padrões de ADR foram avaliados a partir do algoritmo StanfordHIVdb (https://hivdb.stanford.edu). A classificação dos subtipos foi obtida por consenso entre os algoritmos Rega (http://dbpartners.stanford.edu:8080/ RegaSubtyping/stanford-hiv/typingtool/), Scueal (http://classic.datamonkey.org/
dataupload_scueal.php) e Comet (https://comet.lih.lu/).
Resultados: Na amostra, que incluiu indivíduos LP e NLP, foi observada TDR em 29 dos 414 pacientes naïve (7,0% resistentes a qualquer uma das classes de antirretrovirais), 2,2% a inibidores da protease (PI), 2,9% a inibidores nucleósidos da transcriptase reversa (NRTI) e 2,7% a inibidores não nucleósidos da transcriptase reversa (NNRTI). A TDR no grupo NLP foi quase duas vezes superior à do grupo LP, correspondendo a 9,0% e 4,9%, respetivamente. A ADR foi de 62,7% para LP e 34,9%para NLP. A distribuição dos subtipos foi considerada homogénea entre as populações LP e NLP. Em indivíduos LP, 42,4% das sequências foram classificadas como subtipo B e 27,1% como G. Em NLP, 48,0% das sequências foram classificadas como B e 15,4%, como G. Nos grupos LP e NLP, TDR e ADR foram mais comumente
encontradas nas sequências do subtipo B.
Conclusões: A prevalência de TDR foi mais alta no grupo NLP e a de ADR, em LP. O subtipo B foi o mais prevalente e foi onde a maior taxa de TDR e ADR foi encontrada.
Introduction: The incidence of infection by HIV in Portugal is one of the highest in the European Union. Timely diagnosis and regular follow-up in treatment centres are important for prognosis of infected individuals and prevention of new cases. 55,8% of new infections in Portugal meet criteria for late presentation (CD4+ cell count below 350/mm3 or AIDS-defining disease). The objective for this study was to determine the prevalence of transmitted resistance to antiretrovirals (TDR) and acquired resistance to antiretrovirals (ADR) in a population of individuals who were followed by the Department of Infectious Diseases of Hospital Egas Moniz, tested positive for HIV-1 and either had criteria for late presentation (LP) or no criteria for late presentation (NLP). Methods: Genotyping of HIV-1 sequences was performed on samples taken between 2001 and 2017 from 539 individuals and divided into 2 groups (LP and NLP). Prevalence and patterns of resistance mutations had been registered before treatment, according to the reference list by WHO (2009). Prevalence and ADR patterns were evaluated using Stanford HIVdb algorithm (https://hivdb.stanford.edu). Classification into subtypes was performed by consensus between Rega (http://dbpartners.stanford.edu:8080/RegaSubtyping/stanford-hiv/typingtool/), Scueal (http://classic.datamonkey.org/dataupload_scueal.php) and Comet ( https://comet.lih.lu / ) algorithm outputs. Results: In the study sample, including LP and NLP individuals, TDR was detected in 29 of 414 naïve patients. 7,0% showed resistance to any class of ARV, 2,2% to protease inhibitors (PI), 2,9% to nucleoside reverse transcriptase inhibitors (NRTI) and 2,7% to non-nucleoside reverse transcriptase inhibitors (NNRTI). TDR for the NLP groups was almost 2 times higher than TDR for the LP groups (9,0% and 4,9%, respectively). ADR was 62,7% for LP and 34,9% for NLP. The subtype distribution was considered homogeneous between LP and NLP samples. In the LP group, 42,4% of sequences were assigned to subtype B and 27,1% to G. 48,0% of NLP were assigned to subtype B and 15,4%, to G. In both LP and NLP groups, TDR and ADR were more common in subtype B sequences. Conclusions: TDR prevalence was higher in NLP and ADR, in LP. Subtype B was the most prevalent and also the one with the highest rates of TDR and ADR.
Introduction: The incidence of infection by HIV in Portugal is one of the highest in the European Union. Timely diagnosis and regular follow-up in treatment centres are important for prognosis of infected individuals and prevention of new cases. 55,8% of new infections in Portugal meet criteria for late presentation (CD4+ cell count below 350/mm3 or AIDS-defining disease). The objective for this study was to determine the prevalence of transmitted resistance to antiretrovirals (TDR) and acquired resistance to antiretrovirals (ADR) in a population of individuals who were followed by the Department of Infectious Diseases of Hospital Egas Moniz, tested positive for HIV-1 and either had criteria for late presentation (LP) or no criteria for late presentation (NLP). Methods: Genotyping of HIV-1 sequences was performed on samples taken between 2001 and 2017 from 539 individuals and divided into 2 groups (LP and NLP). Prevalence and patterns of resistance mutations had been registered before treatment, according to the reference list by WHO (2009). Prevalence and ADR patterns were evaluated using Stanford HIVdb algorithm (https://hivdb.stanford.edu). Classification into subtypes was performed by consensus between Rega (http://dbpartners.stanford.edu:8080/RegaSubtyping/stanford-hiv/typingtool/), Scueal (http://classic.datamonkey.org/dataupload_scueal.php) and Comet ( https://comet.lih.lu / ) algorithm outputs. Results: In the study sample, including LP and NLP individuals, TDR was detected in 29 of 414 naïve patients. 7,0% showed resistance to any class of ARV, 2,2% to protease inhibitors (PI), 2,9% to nucleoside reverse transcriptase inhibitors (NRTI) and 2,7% to non-nucleoside reverse transcriptase inhibitors (NNRTI). TDR for the NLP groups was almost 2 times higher than TDR for the LP groups (9,0% and 4,9%, respectively). ADR was 62,7% for LP and 34,9% for NLP. The subtype distribution was considered homogeneous between LP and NLP samples. In the LP group, 42,4% of sequences were assigned to subtype B and 27,1% to G. 48,0% of NLP were assigned to subtype B and 15,4%, to G. In both LP and NLP groups, TDR and ADR were more common in subtype B sequences. Conclusions: TDR prevalence was higher in NLP and ADR, in LP. Subtype B was the most prevalent and also the one with the highest rates of TDR and ADR.
Descrição
Palavras-chave
Ciências biomédicas Biologia molecular HIV-1 Diagnóstico tardio CD4 Resistência transmitida e adquirida a ARV Portugal
Contexto Educativo
Citação
Editora
Instituto de Higiene e Medicina Tropical