Pretreatment drug resistance (PDR) can compromise antiretroviral therapy (ART) efficacy and undermine the WHO targets to end the AIDS epidemic as a public health threat by 2030. Thus, we examined the level of PDR in Harare, Zimbabwe. Eligible study participants were adults who were ART naive or individuals with previous ART exposure reinitiating treatment, recruited between October 2018 and February 2020 in a HIV ART treatment clinic, in Harare. HIV drug resistance tests were performed for all specimens with viral load ≥400 copies/mL and interpreted using the Stanford HIVDB Algorithm. Chi-square test or Fisher's exact test was used for comparison of proportions of PDR across ART-naive or prior ART-exposed participants. All statistical analyses were performed using Stata version 14. Overall, 120 samples were genotyped of whom 104 were ART naive and 16 reported previous ART exposure. The overall PDR frequency among all participants was 31% [95% confidence interval (CI): 22.5–39.6]. PDR to any non-nucleotide reverse transcriptase inhibitor (NNRTI) was reported in 29% (95% CI: 21.0–37.9). PDR to nucleotide reverse transcriptase inhibitors (NRTIs) and protease inhibitors were low, found in 3% (95% CI: 0.9–8.2) and 1% (95% CI: 0.02–4.52), respectively. PDR to NNRTIs [efavirenz/nevirapine (EFV/NVP)] was found in 17% (95% CI: 10.5–24.6) and was more than six times higher among people with previous ART exposure than ART-naive people: 63% versus 10%, p < .001. Our study shows that PDR to NNRTIs in Zimbabwe has remarkably increased from the 10.9% prevalence reported in the 2016 WHO survey. Addressing PDR at a national level is a critical need and will be facilitated by fast-tracking the transition to dolutegravir in first-line ART regimens.

中文翻译：

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在津巴布韦开始或重新开始一线抗逆转录病毒治疗的成人的预处理 HIV 耐药性：快速跟踪向基于 Dolutegravir 的一线治疗方案的过渡？

预处理药物耐药性 (PDR) 会影响抗逆转录病毒疗法 (ART) 的疗效，并破坏世卫组织到 2030 年结束艾滋病流行作为公共卫生威胁的目标。因此，我们检查了津巴布韦哈拉雷的 PDR 水平。符合条件的研究参与者是 2018 年 10 月至 2020 年 2 月在哈拉雷 HIV ART 治疗诊所招募的未接受 ART 的成年人或之前接受过 ART 暴露重新开始治疗的个体。对所有病毒载量≥400 拷贝/mL 的样本进行了 HIV 耐药性测试，并使用斯坦福 HIVDB 算法进行解释。卡方检验或 Fisher 精确检验用于比较未接受过 ART 或先前接受过 ART 的参与者的 PDR 比例。所有统计分析均使用 Stata 14 版进行。总体而言，对 120 份样本进行了基因分型，其中 104 份未接受过 ART，16 份报告先前接受过 ART。所有参与者的总体 PDR 频率为 31% [95% 置信区间 (CI)：22.5–39.6]。任何非核苷酸逆转录酶抑制剂 (NNRTI) 的 PDR 报告率为 29%（95% CI：21.0–37.9）。核苷酸逆转录酶抑制剂 (NRTIs) 和蛋白酶抑制剂的 PDR 较低，分别为 3% (95% CI: 0.9–8.2) 和 1% (95% CI: 0.02–4.52)。NNRTIs [依法韦仑/奈韦拉平 (EFV/NVP)] 的 PDR 占 17%（95% CI：10.5-24.6），并且在之前接受过 ART 的人群中比未接受过 ART 的人群高 6 倍以上：63% 对 10 %, 任何非核苷酸逆转录酶抑制剂 (NNRTI) 的 PDR 报告率为 29%（95% CI：21.0–37.9）。核苷酸逆转录酶抑制剂 (NRTIs) 和蛋白酶抑制剂的 PDR 较低，分别为 3% (95% CI: 0.9–8.2) 和 1% (95% CI: 0.02–4.52)。NNRTIs [依法韦仑/奈韦拉平 (EFV/NVP)] 的 PDR 占 17%（95% CI：10.5-24.6），并且在之前接受过 ART 的人群中比未接受过 ART 的人群高 6 倍以上：63% 对 10 %, 任何非核苷酸逆转录酶抑制剂 (NNRTI) 的 PDR 报告率为 29%（95% CI：21.0–37.9）。核苷酸逆转录酶抑制剂 (NRTIs) 和蛋白酶抑制剂的 PDR 较低，分别为 3% (95% CI: 0.9–8.2) 和 1% (95% CI: 0.02–4.52)。NNRTIs [依法韦仑/奈韦拉平 (EFV/NVP)] 的 PDR 占 17%（95% CI：10.5-24.6），并且在之前接受过 ART 的人群中比未接受过 ART 的人群高 6 倍以上：63% 对 10 %,p  < .001。我们的研究表明，津巴布韦对 NNRTIs 的 PDR 比 2016 年 WHO 调查报告的 10.9% 的患病率显着增加。在国家层面解决 PDR 是一项关键需求，将通过在一线 ART 方案中快速过渡到 dolutegravir 来促进。