A Retrospective Study of Prevalence and Viral Mutation Patterns among Adult HIV-Infected Patients in Khon Kaen Regional Hospital
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Objective: To study the prevalence of drug resistance, percentage of patients with successful viral suppression and control, estimate the increase of medication treatment index due to regimen change to the one for resistant virus and the level of viral susceptibility to antiretroviral drugs, i.e., nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and protease inhibitors (PIs) in adult HIV-infected patients in the infectious clinic at Khon Kaen Regional Hospital. Method: This research was a descriptive retrospective study in all eligible patients visiting the clinic during September 1, 2014 to August 31, 2016. The study collected all data from medical records. Results: There were 1658 eligible patients during September 1, 2014 to August 31, 2016, with 79 cases of drug resistance (4.8%). During the first period of data collection (September 1, 2014 to August 31, 2015), there were 1,504 patients visiting the clinic with 34 having drug-resistant infections (2.3 %). During the second period (September 1, 2015 to August 31, 2016), 1,639 patients received the service, 45 of them had drug-resistant infection (2.8%). The annual rate of increase in drug resistance rates was approximately 3 %. Therefore, increased cost of antiretroviral therapy per 100 HIV-infected population was estimated at 103,479-437,454 baht. Proportion of patients with viral load less than 1000 copies/ml in the first period was 97.2% and that in the second period was 97.3%. The study found 97.1 % and 84.4 % of NRTI resistance among those with drug resistant infection in the two periods. The most common drug resistant mutation site was M184V, which led to the resistance to lamivudine (3TC), emtricitabine (FTC), and abacavir (ABC). The second most common mutation site was K65R, causing tenofovir (TDF) resistance. The study found the prevalence of NNRTI resistance were 94.1 and 91.1% among those with drug resistant infection at periods 1 and 2, respectively. The most common mutation sites were K103N and Y181C, causing resistance to nevirapine (NVP) and efavirenz (EFV). Rates of PI resistance were 41.2 and 40.0% among those with drug resistant infection at time 1 and 2, respectively. The most common site of the mutation was L10F, but little or no impact on susceptibility to the drug was found. In two periods of study, concomitant resistance of NRTIs and NNRTIs was at 51.4-66.3 %, resulting in intermediate to high level resistance against 3TC/FTC (84.2-94.2%), EFV (90.2-96.9%), rilpivirine (RPV) (70.8-75%), etravirine (ETR) (56.1-58.9%). Conclusion: Continuing studies on prevalence and patterns of antiretroviral resistance, together with the use of effective strategies such as initial counseling and pre-treatment education to improve and monitor treatment adherence, will increase the quality of patient care and lead to the achievement of indicators for managing the future AIDS epidemic.
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ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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