新疆部分艾滋病病人抗病毒治疗效果和耐药变异分析  

The therapeutic efficacy and occurrence of drug resistance among patients in Xinjiang during the first 12 months of antiretroviral treatment

作　　者：佐合拉·吐尔地[1] 廖玲洁[2] 董永慧[1] 邢辉[2] 孙峰 阮玉华[2] 马祥荣 开赛尔 地力努尔 邵一鸣 

机构地区：[1]新疆维吾尔自治区疾病预防控制中心性病艾滋病预防控制中心,乌鲁木齐830002 [2]中国疾病预防控制中心性病艾滋病预防控制中心,北京102206 [3]伊犁州疾病预防控制中心,新疆伊宁835000 [4]乌鲁木齐市水磨沟区疾病预防控制中心,新疆乌鲁木齐830063 [5]乌鲁木齐市天山区疾病预防控制中心,新疆乌鲁木齐830000 [6]乌鲁木齐市沙依巴克区疾病预防控制中心,新疆乌鲁木齐830000

出　　处：《中国艾滋病性病》2011年第2期107-110,141,共5页Chinese Journal of Aids & STD

基　　金：“十一五”国家科技重大专项(2008ZX10001-004);全球基金第四轮中国艾滋病项目~~

摘　　要：目的观察接受中国现行一线抗病毒药物治疗的艾滋病病人,在治疗1年内免疫功能恢复、病毒抑制效果,以及耐药性产生和发展情况。方法采用Logistic回归分析病毒抑制失败和耐药发生的相关因素。结果共调查156例病人,基线病毒载量<1 000拷贝/ml的病人比例为5.1%,治疗6和12个月后,分别上升到71.1%和70.8%;病人治疗前的CD4细胞数平均值为191个/μl,在治疗6个月和12个月分别达到324个/ml和327个/ml。基线样本的耐药性检测未发现主要耐药突变,治疗6个月有5例(5.2%,5/97)出现耐药突变,治疗12个月后增加到12例(10.6%,12/113),其中7例对核苷类和非核苷类反转录酶抑制剂均有不同程度的耐药。治疗12个月,病毒抑制失败的相关因素是:近1个月内有漏服史(调整OR值:AOR=12.6,P=0.0002)、基线CD4细胞数在100个/μl以下(AOR=6.6,P=0.0026),均为耐药发生的危险因素;而静脉吸毒以外的途径感染则是减少耐药发生的相关因素(AOR=0.2,P=0.0244)。结论大多数艾滋病病人在抗病毒治疗一年内病毒复制得到有效抑制,CD4细胞水平明显升高,但是耐药突变率也在不断升高,需采取有效措施防止耐药的发生,保证抗病毒治疗效果。Objective To evaluate immune reconstitution,viral suppression and the occurrence of drug resistance among patients during the first 12 months of first-line antiretroviral treatment in Xinjiang.Methods Risk factors for failure of viral suppression and HIV drug resistance were analyzed in Logistic regression models.Results At baseline,5.1% of the patients had a viral load less than 1 000 copies/ml,the rates of viral suppression（1 000 copies/ml） at 6 and 12 months of treatment were 71.1%（69/97） and 70.8%（80/113） respectively.The average CD＋4T cell counts were 191,324 and 327 cells/ μl at 0,6 and 12 months of treatment respectively.At 6 months,five patients（5.2%,5/97） were detected to harbor drug resistance virus;the number was increased to 12（10.6%,12/113） at 12 months of treatment;none of the HIV strains from these patients revealed resistance to any antiretroviral drugs at baseline;viruses from seven patients were resistant to both NRTI and NNRTI drugs at different levels.At 12 months of treatment,the risk factor for failure of viral suppression was missingg doses in the previous month（AOR=12.6,P=0.0002）.Having a low baseline CD4 count（100 cells/μl） was associated with increased incidence of HIV drug resistance（Adjusted OR：AOR=6.6,P=0.0026）,but transmission routes other than intravenous drug using decreased the possibility of HIV drug resistance（AOR=0.2,P=0.0244）.Conclusions A large proportion of the patients investigated had successfully suppressed HIV viral replication and had a significant increase of CD＋4T cell counts,while the rate of drug resistance was raised during the first year of treatment.It is essential to take measures to reduce the occurrence of drug resistance.

关 键 词：艾滋病抗病毒治疗 治疗效果 耐药性检测 

分 类 号：R373.9[医药卫生—病原生物学] R512.91[医药卫生—基础医学]