广西16例患AIDS儿童抗病毒治疗病毒学失败者的基因型耐药性研究  

Study on genotype drug resistance in 16 pediatric AIDS cases with virological failure in Guangxi

作　　者：梁淑家[1] 唐志荣[1] 陈杰[1] 闭志友[1] 梁富雄[1] 李剑军[1] 周崇兴[1] 刘伟[1] 

机构地区：[1]广西壮族自治区疾病预防控制中心,南宁530028

出　　处：《中国艾滋病性病》2010年第6期562-564,共3页Chinese Journal of Aids & STD

基　　金：广西自治区卫生厅重点项目(合同号:重200415);第四轮全球基金艾滋病项目资助

摘　　要：目的了解广西自治区患艾滋病(AIDS)儿童抗病毒治疗病毒学失败病例的耐药规律及特点。方法分析16例患AIDS儿童接受过高效抗反转录病毒治疗(HAART),并出现病毒学失败的临床及实验室资料,进行基因型耐药检测并对耐药突变结果进行分析。结果 16例患AIDS儿童的平均年龄(3.4±1.6)岁,平均治疗的时间为(13.2±5.5)个月,平均CD4T淋巴细胞百分比(11.08±7.05)%个,病毒载量的平均值(4.02±0.58)log10 IU/ml。在16例儿童中,基因型耐药检测结果为耐药的有15例,病毒学失败后耐药发生率为93.75%。在15例耐药的儿童中,7例(占46.67%)对非核苷类反转录酶抑制剂(NNRTI)的三种药物全部高度耐药,15例(占100%)对NVP耐药;10例(占66.67%)对DLV高度耐药,1例(占6.67%)为可能耐药;7例(46.67%)对EFV高度耐药,8例(占53.33%)为可能耐药。在15例耐药的儿童中,对核苷类反转录酶抑制剂(NRTI)的耐药突变结果显示:13例(占86.67%)对3TC和FTC高度耐药,1例对AZT高度耐药;1例对ddI高度耐药,1例为可能耐药;1例对d4T高度耐药,2例为可能耐药;1例对ABC高度耐药,2例为可能耐药;1例对TDF高度耐药,1例为可能耐药。结论 15例病毒学失败的艾滋病患儿,对正在使用的抗病毒药有不同程度耐药,需考虑更换新的抗病毒治疗方案。Objective To study the characteristic of drug resistance in the pediatric AIDS cases with virological failure in Guangxi.Method The clinical and laboratory data of 16 pediatric AIDS cases who had received highly active anti-retroviral therapy（HAART） and revealed virological failure were analyzed for drug resistance.Results Patients were 3.4±1.6 years old on average,and the mean time of the treatment was 13.2±5.5 months.The average CD＋4 cell count was 11.08±7.05%.The mean HIV-1 RNA viral load was（4.02±0.58） log 10 IU / ml.The rate of therapeutic failure due to drug resistance was 93.75%.The analysis of non-nucleoside reverse transcriptase inhibitor（NNRTI） drug resistance in 15 cases showed that 7 cases（46.67%） had high resistance to three drugs,all cases were resistant to NVP,10 cases（66.67%） were highly resistant to DLV and 1 was possibly resistant to DLV,7 cases（46.67%） had high resistance to EFV,and 8 cases（53.33%） had a possible drug resistance.The analysis of nucleoside reverse transcriptase inhibitor（NRTI） drug resistance in 15 cases showed that 13 cases had high resistance to 3TC and FTC（86.67%）,1 case had high resistance to AZT,1 case had high resistance and 1 case had possible resistance to ddI,1 case had high resistance and 2 cases had possible drug-resistance to d4T;1 case had high resistance and 2 cases had possible drug resistance to ABC;1 case had high resistance and 1 case had possible drug resistance to TDF.All 16 cases showed sensitivity to the protein inhibitor drugs.Conclusion Fifteen pediatric AIDS cases with virological failure have different resistance to the drugs taken,and change of therapeutic regime should be considered.

关 键 词：艾滋病 儿童患者 高效抗反转录病毒治疗 病毒学 耐药性 

分 类 号：R512.91[医药卫生—内科学]