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치료력이 없는 HIV 감염환자에서 약제내성 빈도

Antiretroviral drug resistance among drug-naive HIV-1 infected patients

류은경|이수진|곽임수|조군제|유학선|박순미|설영미|안순철|김형회|이선희|차동혁|김서린|윤연경
대한내과학회 (The Korean Association Of Internal Medicine)|2007.09|대한내과학회지 (The Korean Journal of Medicine)|제73권 제3호|pp. 243-250

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HIVDrug resistance약제내성사람면역결핍바이러스항레트로바이러스제Antiretroviral agent
주제분류내과학

초록

Background : The prevalence of HIV drug resistance mutations in drug-naive patients has been shown to differ with geographic origin. The purpose of this study is to assess the prevalence of transmitted antiretroviral drug resistance mutations in drug-naive patients in Korea. Methods : Genotypic resistance was determined by the use of the Viroseq Genotyping System in 42 antiretroviral treatment naive HIV-infected patients between March 2005 and July 2006. Transmitted drug resistance was estimated according to the IAS-USA 2005 definition, taking into account only major mutations in the protease and all mutations in the reverse transcriptase, including revertant mutations at codon 215. Results : The median age of the patients was 42 years and 37 (88%) were male. The median CD4+T cell count was 136/mm3 and the mean plasma RNA level was 4.98 log copies/mL. Among 42 patients studied, 37 (88%) were newly diagnosed patients. None of the patients were recent seroconverters; 38 patients (90%) were infected with subtype B and 4 patients were infected (10%) with the non-B subtype strains (2 patients with CRF01-AE 1 as CRF02-AG; 1 patient with subtype A). Of the 42 subjects tested, we found 2 (4.8%) mutations in NRTI (V118I), but did not find a mutation in NNRTI as well as in the PI region. Conclusions : The prevalence of transmitted antiretroviral drug resistance in drug-naive patients is still low in Korean patients.(Korean J Med 73:243-250, 2007)

Abstract

목적 : 최근 내원한 치료력이 없는 사람면역결핍바이러스 감염환자에서 전파된 내성바이러스의 빈도를 알아보고자 하였다. 방법 : 2005년 3월 1일부터 2006년 7월 30일까지 부산대학교병원에 처음 내원한 사람면역결핍바이러스 감염 환자 중 항레트로바이러스제 치료력이 없는 환자들을 대상으로 하였다. HIV-1 유전형 내성 검사는 ViroSeqTM HIV-1 Genotyping System을 사용하였다. 유전형 내성은 International AIDS Society-USA panel의 2005년 합의 지침을 근거로 하여 한 가지 이상의 내성관련 돌연변이가 존재할 때로 정의하였으며, 유전적 아형은 pol 유전자 염기서열을 염기서열분석 프로그램(REGA HIV-1 Subtyping Tool - Version 2.0 과 NCBI Blast genotyping tool)을 이용하여 분석하였다. 결과 : 대상 기간 중 42명의 환자에서 유전형 내성 검사가 시행되었다. 환자들의 평균 나이는 42세였으며 남자 37명(88%), 여자가 5명(12%)이었다. 정중 CD4 세포수는 136/mm3, 평균 혈장 HIV-1 RNA 정량 검사 결과 역가는 4.98 log copies/mL이었다. 유전적 아형은 B형이 38명이었으며 CRF01 AE 2명, CRF02 AG 1명 및 A 형이 1명이었다. 42명 중 2 (4.8%)명에서 뉴클레오시드 역전사효소 억제제(NRTI)에 내성관련 돌연변이가 존재하였으며(V118I), 비뉴클레오시드 역전사효소 억제제 내성과 단백분해효소 억제제에 주 내성인 경우는 없었다. 42명 중 37명(88%)은 발견된 지 1년 미만이었으며, 이들에서 유전형 내성 빈도는 약 4.8%이었다. V118I를 제외하면 NRTI 내성도 없었다. 결론 : 이전 치료력이 없는 사람면역결핍바이러스 감염 환자에서 유전형 내성 빈도는 약 4.8%였다. V118I를 제외하면 전파된 고도내성은 없었다.

참고문헌 (35)

  1. Palella FJ, "Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection", N Engl J Med, 338, pp.853~860 (1998)
  2. Jacobson MA, "Altered natural history of AIDS-related opportunistic infections in the era of potent combination antiretroviral therapy", AIDS, 12(Suppl A), pp.157~163 (1998)
  3. Murphy EL, "Highly active antiretroviral therapy decreases mortality and morbidity in patients with advanced HIV disease", Ann Intern Med, 135, pp.17~26 (2001)
  4. Shafer RW, "Genotypic testing for human immunodeficiency virus type 1 drug resistance", Clin Microbiol Rev, 15, pp.247~277 (2002)
  5. Cane PA, "Stability of transmitted drug-resistant HIV-1 species", Curr Opin Infect Dis, 18, pp.537~542 (2005)
  6. Tang JW, "Transmission of HIV-1 drug resistance", J Clin Virol, 30, pp.1~10 (2004)
  7. Boden D, "HIV-1 drug resistance in newly infected individuals", JAMA, 282, pp.1135~1141 (1999)
  8. Little SJ, "Reduced antiretroviral drug susceptibility among patients with primary HIV infection", JAMA, 282, pp.1142~1149 (1999)
  9. Yerly S, "Transmission of antiretroviral-drug-resistant HIV-1 variants", Lancet, 354, pp.729~733 (1999)
  10. Weinstock H, "Prevalence of mutations associated with reduced antiretroviral drug susceptibility among human immunodeficiency virus type 1 seroconverters in the United States, 1993-1998", J Infect Dis, 182, pp.330~333 (2000)
  11. Grant RM, "Time trends in primary HIV-1 drug resistance among recently infected persons", JAMA, 288, pp.181~188 (2002)
  12. Little SJ, "Antiretroviral-drug resistance among patients recently infected with HIV", N Engl J Med, 347, pp.385~394 (2002)
  13. UK Collaborative Group on Monitoring the Transmission of HIV Drug Resistance, "Analysis of prevalence of HIV-1 drug resistance in primary infections in the United Kingdom", BMJ, 322, pp.1087~1088 (2001)
  14. Devereux HL, "Rapid decline in detectability of HIV-1 drug resistance mutations after stopping therapy", AIDS, 13, pp.123~127 (1999)
  15. Perno CF, "Low prevalence of primary mutations associated with drug resistance in antiviral-naive patients at therapy initiation", AIDS, 16, pp.619~624 (2002)
  16. Little SJ, "Persistence of transmitted drug-resistant virus among subjects with primary HIV infected deferring antiretroviral therapy", 11th Conference on Retyroviruses and Opportunistic Infections (2004)
  17. Brenner BG, "Persistence and fitness of multidrug-resistant human immunodeficiency virus type 1 acquired in primary infection", J Virol, 76, pp.1753~1761 (2002)
  18. De Ronde A, "Establishment of new transmissible and drug-sensitive human immunodeficiency virus type 1 wild types due to transmission of nucleoside analogue-resistant virus", J Virol, 75, pp.595~602 (2001)
  19. Novak RM, "Prevalence of antiretroviral drug resistance mutations in chronically HIV-infected, treatment- naive patients: implications for routine resistance screening before initiation of antiretroviral therapy", Clin Infect Dis, 40, pp.468~474 (2005)
  20. Weinstock HS, "The epidemiology of antiretroviral drug resistance among drug-naive HIV-1-infected persons in 10 US cities", J Infect Dis, 189, pp.2174~2180 (2004)
  21. Wensing AM, "Prevalence of drug-resistant HIV-1 variants in untreated individuals in Europe: implications for clinical management", J Infect Dis, 192, pp.958~966 (2005)
  22. Cane P, "Time trends in primary resistance to HIV drugs in the United Kingdom: multicentre observational study", BMJ, 331, pp.1368~ (2005)
  23. Saag MS, "Efficacy and safety of emtricitabine vs stavudine in combination therapy in antiretroviral- nave patients: a randomized trial", JAMA, 292, pp.180~190 (2004)
  24. Jourdain G, "Intrapartum exposure to nevirapine and subsequent maternal responses to nevirapine-based antiretroviral therapy", N Engl J Med, 351, pp.229~240 (2004)
  25. Pillay D, "The impact of transmitted drug resistance on the natural history of HIV infection and response to first-line therapy", AIDS, 20, pp.21~28 (2006)
  26. Sax PE, "Should resistance testing be performed for treatment-naive HIV-infected patients?: a cost-effectiveness analysis", Clin Infect Dis, 41, pp.1316~1323 (2005)
  27. Weinstein MC, "Use of genotypic resistance testing to guide HIV therapy: clinical impact and cost-effectiveness", Ann Intern Med, 134, pp.440~450 (2001)
  28. Hirsch MS, "Antiretroviral drug resistance testing in adults infected with human immunodeficiency virus type 1: 2003 recommendations of an International AIDS Society-USA Panel", Clin Infect Dis, 37, pp.113~128 (2003)
  29. Hammer SM, "Management of newly diagnosed HIV infection", N Engl J Med, 353, pp.1702~1710 (2005)
  30. Hammer SM, "Treatment for adult HIV infection: 2006 recommendations of the International AIDS Society-USA panel", JAMA, 296, pp.827~843 (2006), 2006
  32. Johnson VA, "Update of the drug resistance mutations in HIV-1: Fall 2005", Top HIV Med, 13, pp.125~131 (2005)
  33. Park SW, "Genotypic resistance of antiretoriviral drugs among drug-naive HIV type 1 patients with the background of long-term access-easy zidovudine therapy", AIDS Res Hum Retroviruses, 19, pp.1039~1043 (2003)
  34. HIV resistnace and genotypic charateristics. In: A Study on Emerging Infectious Diseases in Korea-Korea Health 21 R&D project(HMP-99-M- 04-0002), "Kim J", Ministry of Health and Welfare, ~ (2002)

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