河南省长期接受抗病毒治疗的艾滋病患者耐药横断面分析  

Cross-sectional analysis on drug resistance profile of acquired immune deficiency syndrome patients receiving a long-term antiretroviral treatment in Henan

作　　者：崔为国[1] 刘佳[1] 薛秀娟[1] 孙国清[1] 田遂安[1] 刘春华[1] 程耀武[2] 李琦 王哲[1] 

机构地区：[1]河南省疾病预防控制中心性病艾滋病防治研究所,450016 [2]河南省上蔡县疾病预防控制中心 [3]河南省沈丘县疾病预防控制中心

出　　处：《中华实验和临床病毒学杂志》2012年第3期168-171,共4页Chinese Journal of Experimental and Clinical Virology

基　　金：国家“十一五”科技重大科技专项课题：防治艾滋病规模化现场流行病学和干预研究（编号：2009ZX10001-017）

摘　　要：目的阐明河南省长期接受艾滋病抗病毒治疗患者的耐药情况，为这类患者继续有效的治疗提供参考依据。方法抽取河南省两个艾滋病重点县中2004年左右开始接受一线抗病毒治疗的艾滋病患者，进行CD4＋T淋巴细胞、病毒载量和基因型耐药检测。结果两个县共抽取164例艾滋病患者，这些患者的CD4＋T淋巴细胞计数的中位数（四分位数）为398．00（242．00—489．50）个／μl，有32．32％的患者体内检测不到病毒。有95例患者的病毒载量大于1000拷贝／ml，其中的77例患者完成了耐药检测。在这77例患者中，有耐药突变（任意一种）发生的患者占到68．83％，其中NNRTIs类突变较高为64．94％，NRTIs类突变为55．84％，无PIs类突变发生。NNRTIs类耐药突变中发生最多的是K103N／S（44．16％），其次为G190A／S（19．48％）和Y181C／V（14．29％）。NRTIs类耐药突变中发生最多的是胸苷类似物突变（thymidineanaloguemutations，TAMs），≥1TAM占46．75％，TAM-1／TAM．2占24．68％，M184V／I为24．68％。77例患者中，对NRTIs类药物ddI、3TC、AZT、D4T和TDF产生耐药的患者分别占50．65％、33．77％、48．05％、50．65％和46．75％。对NNRTIs类药物EFV、NVP和DLV产生耐药的患者分别占64．94％、64．94％和62．34％。结论河南省长期接受抗病毒治疗的艾滋病患者的耐药情况严峻，需要对这部分患者重点关注并及时调整治疗方案。Objective To elucidate the condition of drug resistance among acquired immune deficiency syndrome （AIDS） patients with a long-term antiretroviral treatment in Henan province, provide some useful data for such patients to continue effective treatment. Method Patients beginning first-line antiretroviral treatment before and after 2004 were selected in two counties of Henan. CD4 ＋ T cells, virus load and genotypic resistance（In-house） were tested. Results A total of 164 patients were selected in two counties, with a median （interquartile range, IQR） CD4 ＋T cells 398.00 （242.00-489.50）cells/trl, 32.32% of the patients had a virus load lower than the lowest detected level. Ninety-five patients had a virus load more than 1000 copies/ml, 77 of them completed the drug resistance test, drug resistance mutations occurred in 68.83% , the NNRTIs and NRTIs mutations were found in 64.94% and 55.84% of them, respectively, no PIs mutations were detected. K103N/S （44. 16% ） was the most frequent NNRTIs mutations that have occurred, followed by G190A/S （ 19. 48% ） and Y181C/V （ 14. 29% ）. Thymidine analogue mutations （TAMs） was the most common NRTIs mutations that have occurred., i〉 1TAM accounted for 46.75%, TAM-I/TAM-2 accounied for 24. 68%. M184V/I was also the NRTIs mutations. Among the 77 patients, the proportion of patients who had resistance to the NRTIs： ddI, 3TC, AZT, D4T and TDF was 50. 65%, 33.77%, 48.05%, 50. 65% and 46. 75% respectively, the proportion of patients who had resistance to the NNRTIs： EFV, NVP and DLV was 64.94% , 64.94% and 62.34% , respectively. Conclusion The situation of drug resistance among AIDS patients treated with a long-term antiretroviral treatment in Henan province was serious, more attention and timely treatment adjustment are needed to such patients with AIDS.

关 键 词：获得性免疫缺陷综合征 药物耐受 病毒 抗病毒药 横断面研究 

分 类 号：R51[医药卫生—内科学]