临沧市2012年高效抗反转录病毒治疗失败的AIDS患者耐药基因变异分析  

Drug resistance mutations in AIDS patients failing highly active antiretroviral therapy in Lincang, Yunnan province, in 2012

作　　者：杨翕然 杨翠先 杨绍敏 边中启[3] 

机构地区：[1]云南省传染病专科医院艾滋病关爱中心检验科,昆明650301 [2]昆明医科大学研究生部 [3]成都军区昆明总医院感染科,650032

出　　处：《传染病信息》2014年第3期164-166,共3页Infectious Disease Information

基　　金：国家"十一五"科技重大专项(2012ZX10001-002)

摘　　要：目的了解临沧市2012年经高效抗反转录病毒治疗(highly active antiretroviral therapy,HAART)失败的AIDS患者耐药基因的变异情况。方法调查HAART失败AIDS患者的流行病学特征,检测CD4+T淋巴细胞计数和病毒载量,对HIV RNA>1×103copies/ml的患者行HIV-1耐药基因检测。结果 66例中有53例检出基因耐药突变。最常见的核苷类反转录酶抑制剂耐药突变位点为M184V、D67N和K70R,非核苷类反转录酶抑制剂耐药突变位点为K103N、G190A和V179D。仅发现3个蛋白酶抑制剂突变位点,分别为D33F、M46I和L76V。结论临沧市AIDS患者出现较多反转录酶抑制剂突变位点是一线抗反转录病毒治疗失败的主要原因。在选择二线治疗方案时,增加蛋白酶抑制剂可避免多重耐药导致的治疗失败。Objective To investigate HIV drug resistance mutations in AIDS patients failing highly active antiretroviral therapy （HAART） in Lincang, Yunnan province, in 2012. Methods Epidemiological characteristics of AIDS patients failing in HAART were investigated. CD4＋T lymphocyte count and viral load were detected, and HIV-1 resistance testing was conducted on those patients with viral load more than 1000 copies/ml. Results Among 66 patients failing in HAART, drug resistance mutations were found in 53 patients. The most common nucleoside reverse transcriptase inhibitor resistance mutations were M184V, D67N and K70R, and non-nucleoside reverse transcriptase inhibitor resistance mutations were K103N, G190A and V179D. Only 3 protease inhibitor （P I ） resistance mutations were found, and they were D33F, M46I and L76V, respectively. Conclusions The emergence of reverse transcriptase resistance mutations is the main reason for the failure of first-line antiretroviral therapy （ART） in AIDS patients in Lincang, Yunnan province. Therefore, when switching to second-line ART, the increased use of PI can avoid ART failure due to multidrug resistance.

关 键 词：获得性免疫缺陷综合征 抗逆转录病毒治疗 高效 抗药性 

分 类 号：R512.91[医药卫生—内科学] R915[医药卫生—临床医学]