湖北省2006年艾滋病抗病毒治疗耐药监测结果分析  

Monitoring drug resistance among AIDS patients on antiretroviral treatment in Hubei Province(2006)

作　　者：汤恒[1] 詹发先[1] 陈慧萍[1] 彭庭海[1] 戴涌[1] 褚小刚[1] 

机构地区：[1]湖北省疾病预防控制中心,武汉430079

出　　处：《公共卫生与预防医学》2007年第5期26-28,共3页Journal of Public Health and Preventive Medicine

摘　　要：目的了解湖北省艾滋病患者接受免费抗病毒治疗的效果,分析在抗病毒治疗过程中HIV耐药出现情况以及影响因素。方法对湖北省接受抗病毒治疗的239名艾滋病患者进行了调查,采集抗凝全血,测定CD4^+ T淋巴细胞以及病毒载量,同时扩增HIV-1 pol区基因片段的核酸序列,并进行序列测定及耐药基因型分析。结果艾滋病患者在接受抗病毒治疗平均24个月后,主要临床表现明显改善,CD4>200比例平均达到78.67%,病毒载量低于检测限的比例平均达到59%。病毒载量低于检测限的比例与在固定时间服药>90%的比例存在线性关系。在病毒载量>1000拷贝/ml的78名艾滋病患者中,通过PCR共扩增出51份HIV基因片断,其中对NRTI类药物中度以上耐药的比例达到19.84%。对NNRTIs类药物高度耐药比例高达28.16%,其中对2种药耐药比例达到26.88%,3种药均耐药比例达到17.28%。结论随着抗病毒治疗时间的延长,耐药性逐渐增加,出现了对NNRTIs类药物的高度耐药和交叉耐药,对NRTIs中高度耐药的毒株也大量出现,这将导致临床用药选择极为困难。Objective To understand the effectiveness among AIDS patients receiving national free antiretroviral therapy, and analyze the occurrence of HIV-1 drug resistance and its influencing factors in Hubei province. Methods A survey of 239 AIDS patients with HAART was conducted, anticoagulated blood was collected and CD4 cell count and viral load measurement were performed. HIV-1 pol genes were amplified and sequenced for genotypic drug resistance. Results Following an average of 24-month antiretroviral treatment, the major clinical symptoms were improved significantly,78.67% having a CD4 above 200/μl. The percentage of patients with viral load below the detection limit was 59% and was linearly correlated to that of the patients who adhered to the regimen over 90% at a fixed time. 51 HIV-1 pol genes were amplified among 78 AIDS patients with viral load above 1 000 copies/ml. Among these patients, 19.84% were found to be resistant to NRTIs at the intermediate level and above, 28.16% to NNRTIs at high level with 26. 88% to 2 drugs and 17. 28% to 3 drugs. Conclusion As the antiretroviral treatment continued, drug resistance to NRTIs and NNRTIs gradually accumulated. Since there are very limited drugs for AIDS treatment in China at present, therefore causing great trouble in clinical practice. Drug resistance monitoring should be conducted among AIDS patients, and when drug resistance developing treatment failure, second-line regimen should be considered, so as to minimize the widespread transmission of drug-resistant HIV strains.

关 键 词：艾滋病 高效抗逆转录病毒治疗 耐药监测 

分 类 号：R512.91[医药卫生—内科学]