四川省凉山州HIV耐药毒株流行及其相关因素分析  

Drug resistance and associated factors on HIV in Liangshan prefecture, Sichuan province

作　　者：王启兴[1] 王霞[2] 陈彬[2] 马志凌[1] 梁姝[3] 廖玲洁[2] 马名驹[1] 卫大英[1] 秦光明[3] 阮玉华[2] 邵一鸣 邢辉[2] 

机构地区：[1]四川省凉山州疾病预防控制中心,西昌615000 [2]中国疾病预防控制中心性病艾滋病预防控制中心 [3]四川省疾病预防控制中心

出　　处：《中华流行病学杂志》2011年第11期1082-1086,共5页Chinese Journal of Epidemiology

基　　金：中国-默沙东艾滋病合作项目（2009DFB30420）;国家科技重大专项（2008ZX10001-004）

摘　　要：目的了解四川省凉山州HIV耐药株的流行现况和相关影响因素。方法于2010年8—10月，采用横断面调查方法收集凉山州7个县（市）317名接受抗病毒治疗艾滋病患者的流行病学资料和治疗数据，同时采集血样进行CD4^＋T淋巴细胞、病毒载量（vL）和耐药基因型突变检测。结果调查对象VL〈1000copy／ml的比例为73．50％（233／317）；CD4^＋T淋巴细胞数中位数（M）为329cell／μl，总耐药率为8．20％（26／317）。84名病毒抑制失败的患者中，总耐药率为30．95％（26／84）。对非核苷类反转录酶抑制剂耐药率为28．57％（24／84）、对核苷类反转录酶抑制剂耐药率为8．33％（7／84）、对蛋白酶类药物耐药率为1．19％（1／84）。多因素分析显示，影响耐药发生的因素有通过静脉吸毒感染（AOR=3．37，95％CI：1．06～10．66，P=O．0390）、调查前无原因的慢性腹泻〉1个月（AOR=8．38，95％CI：1．87～37．69，P=0．0055）、CD4^＋T淋巴细胞数〈200cell／μl（AOR=3．48，95％CI：1．29～9．39，P=0．0139）和来自布拖县（AOR=17．68，95％CI：4．97—62．86，P〈0．0001）。22名耐药的患者85．00％集中在布拖县，通过布拖县与其他地区的比较，发现民族为彝族（AOR=17．35，95％CI：2．01～149．73，P=0．0095）、文化程度为小学及以上（AOR=O．18，95％CI：0．08～0．42，P〈0．0001）、婚姻状况为已婚或同居（AOR=8．17，95％CI：2．35～28．39，P=0．001）、近1个月按要求按时按量服用抗病毒药的比例≥90．00％（AOR=O．05，95％CI：0．02～0．13，P〈0．0001）与耐药的产生有相关性。结论凉山地区艾滋病抗病毒治疗获得较好效果。不同地区耐药率差异较大。需要重视静脉吸毒人群耐药预防，并强化依从性教育和监督。Objective To investigate the HIV drug resistance among HIV/AIDS patients who had received highly active antiretroviral treatment （HAATR） in Liangshan prefecture and related factors. Methods This investigation was conducted from August to October 2010. Data on epidemiology, treatment, CD4 ＋ T cell, viral load and drug resistance tests were collected. Results 233 （73.50%） had a viral load of 〈 1000 copy/ml, with the median CD4^＋T cell count as 329 cell/gl. 26 samples appeared to be drug resistant, with the rate as 8.20%. Among 84 patients with antiviral therapy failure, the overall drug resistance rate was 30.95%（26/84）. While 24 （28.57%） were resistant to non-nucleoside reverse transcriptase inhibitor （NNRTI） drugs. Among nucleoside reverse transcriptase inhibitors （NRTI）, 7 （8.33%） were resistant. 1 （1.19%） had protease inhibitor （PI）resistance mutahons identified. Factors that significantly assocmted with drug resistance would include：being injecting drug users （AOR=3.37,95%CI： 1.06-10.66,P=0.0390） ,having had chronic diarrhea 〉1 month （AOR=8.38, 95% CI： 1.87-37.69, P-----0.0055） , having had CD4^＋T cell〈200 （AOR=3.48, 95% CI： 1,29-9.39, P=0.0139）, being residents from Butuo area （AOR=17.68, 95% CI： 4.97-62.86, P〈0.0001 ）. When comparing with other areas, data from Butuo showed that people who carried Yi ethnicity （AOR=17.35,95% CI： 2.01-149.73, P=0.0095） and were literate （having had primary or higher levels of education） （AOR=0.18, 95% CI： 0.08-0.42, P〈0.0001）, being married or having cohabited relations （AOR= 8.17,95% CI： 2.35-28.39, P-± 0.001 ） were found to be less adherent （AOR=0.05, 95% CI： 0.02-0.13, P〈0.0001） to the treatment. Conclusion Successful antiviral outcomes were seen among those AIDS patients under treatment, in Liangshan prefecture. Resistance rates were significantly different in regions. For IDUs, enforcement on subjects including prevention on drug resistance, adherence to HAART and

关 键 词：艾滋病毒 抗病毒治疗 静脉吸毒者 耐药 

分 类 号：R512.91[医药卫生—内科学]