18例抗病毒治疗失败儿童艾滋病患者耐药基因突变规律研究  

Study on drug resistance gene mutation in 18 pediatric AIDS cases after antiretroviral therapy failure

作　　者：赵燕[1] 张福杰[1] 刘志英[2] 程耀武[3] 孙鑫[1] 赵红心[2] 

机构地区：[1]中国疾病预防控制中心性病艾滋病预防控制中心,北京100050 [2]北京地坛医院,北京100011 [3]河南省上蔡县疾病预防控制中心,上蔡463800

出　　处：《传染病信息》2007年第6期362-365,共4页Infectious Disease Information

摘　　要：目的对儿童艾滋病抗病毒治疗失败病例的耐药基因突变规律及特点进行研究。方法分析18例接受过高效抗逆转录病毒治疗并已经出现病毒学及免疫学失败儿童艾滋病患者的横断面临床及实验室资料,对其耐药突变结果进行分析。结果患者年龄11.6±2.4岁,治疗的时间为36±12个月,其中15例患者曾经接受过成人抗病毒药物治疗,患者的 CD4^+T 淋巴细胞为34±30个/μl(3～96个/μl),病毒载量为5.23±0.57 log10 copies/ml(4.27～6.53 log10 copies/ml)。耐药发生率为100%。对非核苷类逆转录酶抑制剂(NNRTIs)耐药突变结果分析显示:所有患者均对奈韦拉平(NVP)产生高度耐药,对依非韦伦(EFV)高度耐药的有16例。对核苷类逆转录酶抑制剂(NRTIs)耐药突变结果分析显示:对拉米夫定(LAM)高度耐药的有14例,对去羟肌苷(ddI)高度耐药的有11例,对齐多夫定(AZT)高度耐药的有14例,对司他夫定(d4T)高度耐药的有16例。重要突变位点包括 Y181C(9例)、K103N(7例)、G190A(8例)、TAMs(17例)、M184V(10例)、K65R(5例)、Q151M(2例)。结论该组治疗失败儿童患者对正在使用的 NRTIs 及 NNRTIs 均已产生高度耐药,须考虑更换新的抗病毒治疗方案。Objective To study the features of drug resistance gene mutation in 18 pediatric AIDS patients after antiretroviral therapy failure. Methods We collected the latest clinical and laboratory data of 18 AIDS pediatric patients receiving highly active antiretroviral therapy and analyzed the drug resistance gene mutation. Results The patients were 11.6 ±2.4 years old. The mean time of the treatment was 36 ±12 months. Fifteen of the patients had a history of taking adult formulation. The mean CD4~ cell count was 34 ± 30 / μl （3-96 /μl） and the mean H1V-1 RNA viral load was 5.23 ±0.57 log10 copies/ml （4.27-6.53 log10 copies/ml ）,and the rate of drug resistance was 100%. The results of the non-nucleoside reverse transcriptase inhibitor showed all patients developed high resistance to navirapine, and 16 cases to efavirenz. The results about resistance to nucleoside reverse transcriptase inhibitor indicated that high resistance to lamivudine, didanosine, zidovudine, and stavudine occurred in 14 cases, 11 cases, 14 cases and 16 cases, respectively. The key mutations sites included Y181C （9 cases）, K103N （7 cases ）, G190A （8 cases）, TAMs （17 cases）, M184V （10 cases）, K65R （5 cases）, and Q151M （2 cases）. Conclusion The pediatric patients in this cohort have a high drug resistance rate to nucleoside and non- nucleoside reverse transcriptase inhibitors, so it is suggested to consider another antiviral therapy regimens.

关 键 词：儿童 艾滋病 高效抗逆转录病毒治疗 耐药 

分 类 号：R512.91[医药卫生—内科学]