广东省不同感染途径HIV/AIDS病人HAART后HIV-1耐药性分析  

Analysis on drug resistance in HIV/AIDS patients with HAART through different infection routes in Guangdong

作　　者：蔡晓莉[1] 兰芸[1] 李俊彬[1] 胡凤玉[1] 蔡卫平[1] 

机构地区：[1]广州市第八人民医院,广州510060

出　　处：《中国艾滋病性病》2015年第5期369-372,共4页Chinese Journal of Aids & STD

基　　金：十二五国家科技重大专项(2012ZX10001003);广州市科信局民生科技重大专项(201300000092)~~

摘　　要：目的对比广东省不同感染途径艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人),高效抗反转录病毒治疗(HAART)后,HIV抑制情况及耐药发生情况。方法收集2013年广东省HAART>1年、经性途径和静脉吸毒途径感染的HIV/AIDS病人的血浆,测定HIV-1核糖核酸(RNA);选取病毒载量>1000拷贝/mL的标本,检测HIV-1基因分型及耐药位点。结果 1)2013年广东省治疗满1年的在治的经性途径及静脉吸毒感染的HIV/AIDS病人,其病毒学抑制失败率分别为6.98%(330/4726)和28.69%(459/1600),差异有统计学意义(χ2=16.40,P<0.01)。2)两种传播途径病毒学未抑制病人,其核苷类反转录酶区耐药突变位点均以M184IV为主,突变比例差异有统计学意义(χ2=6.41,P=0.01);非核苷类反转录酶区常见的耐药突变位点均以K103NS、Y181CV、G190A为主;蛋白酶区次要突变位点以L10IV和A71TV为主。在性途径感染病人中,检出蛋白酶区主要耐药位点L90M。3)性途径感染及静脉吸毒病人的总体耐药率分别为2.65%(123/4649)和7.00%(109/1557),病毒抑制失败耐药率分别为64.74%(123/190)和45.42%(109/240),差异均有统计学意义(χ2=61.32、15.93,P均<0.01)。4)性途径感染及静脉吸毒传播病人,仅对核苷类反转录酶药物拉米夫定(3TC)、阿巴卡韦(ABC)和恩曲他滨(FTC)的耐药率差异有统计学意义(χ2分别为16.33、13.33和17.08,P均<0.01)。结论广东省经性途径感染的HIV/AIDS病人,治疗后病毒抑制率高于静脉吸毒感染者。在病毒学失败病人中,静脉吸毒感染者耐药率低于性途径感染者。静脉吸毒感染者的治疗依从性差,需重点做好依从性管理。Objective To understand the characteristics of anti-HIV drug resistance of failure treatment among HIV/AIDS patients infected through different routes in Guangdong province who had received highly active antiretroviral therapy（HAART）for more than one year.Methods Plasma of HIV/AIDS patients infected through sex or intravenous drug use（IDU）who had received HAART for more than one year were collected,HIV-1viral load（VL）was detected.For patients whose VL above 1000copies/mL,HIV-1genotype and drug resistance were detected.Results 1）The treatment failure rates of HIV/AIDS patients received HARRT in Guangdong who infected through sex and that of patients infected through IDU were 6.98%（330/4726）and 28.69%（459/1600）,there was significant difference（χ2=16.40,P〈0.01）.2）Resistant mutation in nucleoside reverse transcriptase area is mainly M184 IV in patients infected through sex and through IDU;common resistance mutations in non-nucleoside reverse transcriptase area are K103 NS,Y181CV and G190A;and secondary mutations in protease region are L10 IV and A71 TV.L90M,main resistance mutation in protease region,was detected only in patients infected through sex.3）Total drug resistance rates in patients infected through sex and that of patients infected through IDU were2.65%（123/4649）and 7.00%（109/1557）,and drug resistance rates of virological failure in patients infected through sex and IDU were 64.74%（123/190）and45.42%（109/240）,there were significant differences（χ2=61.32 and 15.93,all P〈0.01）.4）The differences in drug resistance rates of 3TC,ABC and FTC were statistically significant（χ2=16.33,13.33 and17.08,all P〈0.01）between patients infected through sex and IDU.Conclusion The HIV/AIDS patients received HARRT in Guangdong who infected through sex have higher treatment failure rate than those infected through IDU.Among virological failure patients,those who infected through IDU have lower drug resistance rate than those infected through sex.As HIV/AIDS patients i

关 键 词：高效抗反转录病毒治疗 艾滋病病毒感染者/艾滋病病人 耐药 性途径 静脉吸毒 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]