我国河南地区HIV感染者高效抗逆转录病毒治疗及耐药变异情况研究  

Cohort study of highly active antiretroviral therapy and drug resistant mutation in Henan Province, China

作　　者：张旻[1] 韩晓旭[1] 胡清海[1] 崔为国[2] 赵彬[1] 代娣[1] 张子宁[1] 尚红[1] 

机构地区：[1]中国医科大学附属第一医院检验科卫生部艾滋病免疫学重点实验室,沈阳110001 [2]河南省疾病预防控制中心

出　　处：《中华检验医学杂志》2008年第10期1101-1105,共5页Chinese Journal of Laboratory Medicine

基　　金：卫生部艾滋病防治研究项目资助课题（WA2006-02）;辽宁省教育厅重点实验室项目资助课题（20060906）;辽宁省教育厅高等学校创新团队项目资助课题（2006T134）;辽宁省医学重点专科项目（辽卫函字[2007]499号）

摘　　要：目的建立耐药变异研究队列，以明确我国HIV／AIDS患者抗病毒治疗反应及耐药变异发生和变化情况。方法招募HIV感染者116例，每半年进行1次问卷调查，同时进行CD4^＋T淋巴细胞计数、病毒载量和耐药检测。结果应用AZT／DDI／NVP或IMT／DDI／NVP方案者，治疗36个月后CD4^＋T淋巴细胞计数仍维持在较高水平[（470±251）个／ml]，病毒载量低于治疗前水平，随着治疗时间的延长，耐药逐渐增加；更换为AZT／3TC／NVP或D4T／3TC／NVP方案者，随着治疗时间的延长，CD4^＋T淋巴细胞计数逐步下降，病毒载量升高，耐药明显上升；治疗前仅1例存在原发非核苷类逆转录酶抑制剂（NNRTI）高度耐药突变，治疗6个月有2例出现了交叉耐药，治疗12个月后出现了蛋白酶抑制剂（PI）LPV的中度耐药，治疗18个月后NNRTI的高度耐药明显增加，治疗36个月后5例出现多药耐药和交叉耐药。结论我国艾滋病抗病毒治疗前原发耐药很少，随着治疗时间延长，耐药突变逐渐增加，虽然治疗方案较少，但坚持长期治疗仍能保持治疗效果，建议根据耐药检测结果更换治疗方案。Objective To build the cohort of drug resistance and analyze treatment efficiency of AIDS patients and situation of drug resistant mutations among HIV-1 infected individuals. Methods A cohort of 116 HIV-1 infected patients was built and their treatment progress were acquired once every 6 months. At the same time CD4^＋ T cell counts and HIV-1 viral load were measured and genotyping for drug resistance was determined by a home brew nested PCR. Results The CD4^＋T cell count（470 ±251/ml） was higher than that before treatment in patients who were treated by AZT/DDI/NVP or D4T/DDI/NVP. The viral load was lower than that before treatment. The drug resistant mutation frequency increased gradually along with treatment. The CD4^＋ T cell count was decreased and viral load was increased and the prevalence of drug resistant mutation was increased in the patients who changed regimens to AZT/3TC/NVP or D4T/3TC/ NVP. Only one primary mutation that was resistant to non-nucleoside reverse transcriptase inhibitors （NNRTIs） was detected in the naive patients. The cross-resistant mutation was detected in two patients after 6 months treatment. The intermediate resistance to lopinavir （LPV） was detected after 12 months treatment. The prevalence of high-grade resistances to NNRTIs was increased obviously, and the prevalence of multl-resistance and cross-resistance was detected in 5 patients after 36 months treatment. Conclusions The prevalence of primary mutation was rare in naive HIV-1 infected patients. The prevalence of drug resistant mutation was increased gradually along with treatment. Although few regimens were available, the treatment effect could last relatively long period of time if patients keep taking medicine stably. The regimens could be changed according to the results of drug resistant test.

关 键 词：HIV感染 抗逆转录病毒治疗 高效 抗药性 病毒 

分 类 号：R686[医药卫生—骨科学]