不同感染途径HIV患者治疗后的耐药突变及影响因素分析  

Drug resistance mutations and their influencing factors in the patients infected with HIV-1 through different routes after antiretroviral therapy

作　　者：路新利[1] 康现江[1] 赵宏儒[2] 赵翠英[2] 王伟[2] 白广义[2] 李岩[2] 陈素良[2] 

机构地区：[1]河北大学生命科学学院,河北保定071002 [2]河北省疾病预防控制中心,石家庄050021

出　　处：《解放军医学杂志》2015年第7期591-594,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的分析河北省不同感染途径的HIV患者治疗后基因突变情况及其相关影响因素。方法采集正在接受抗病毒治疗的HIV患者血浆,采用基因型检测法检测HIV-1 pol区突变基因并分析其耐药性。结果 266例患者中157例发生了基因突变,耐药发生率59.0%。266例患者中高度耐药发生率为NVP 65.8%(175/266)、3TC 41.7%(111/266)、F TC 4 1.7%(1 1 1/2 6 6)、E F V 3 0.1%(8 0/2 6 6)、D D I 5.6%(1 5/2 6 6)、D 4 T 4.1%(1 1/2 6 6)、A ZT 3.0%(8/2 6 6)、A B C3.0%(8/266)。经血感染的HIV患者耐药发生率高于性途径和母婴途径,但χ2检验结果显示这3种途径之间在NNRTIs编码区Y181C、K103N、V108I、K101E等主要突变位点(χ2=4.796,P=0.531),NRTIs编码区M184V/I、M41L、T215F、T215Y(χ2=5.261,P=0.511),PIs编码区A71V/T、L10I、M46L、Q58E(χ2=6.150,P=0.407)的差异均无统计学意义。OR值计算和95%CI分析表明,患者年龄、感染途径、CD4+T淋巴细胞数、初始治疗方案与HIV-1耐药突变的发生存在显著相关性(P<0.05)。结论在HIV治疗过程中应适时进行CD4+T淋巴细胞、病毒载量和耐药监测,评估疾病进程,使引起耐药的相关因素的影响降到最低,并及时更新治疗方案。Objective To analyze HIV-1 drug resistance mutations and relative factors in the patients infected with HIV-1through different routes after having received highly active anti-retroviral therapy（HAART） in Hebei province. Methods Plasma samples were collected from patients who were infected with HIV through different routes. Detection of HIV-1 RNA pol region was carried out by detection of genotype, and HIV drug resistance mutations were analyzed. Results Among 266 patients, 157 developed mutation. The rate of the drug-resistance was 59.0%. Among 266 patients, drug-resistance rates were ranked from high to low as follows： NVP 65.8%（175/266）, 3TC 41.7%（111/266）, FTC 41.7%（111/266）, EFV 30.1%（80/266）, DDI 5.6%（15/266）, D4 T 4.1%（11/266）, AZT 3.0%（8/266） and ABC 3.0%（8/266）. The drug-resistance rate of blood infection patients was much higher than that of sexual and mother-to-child transmission ones, but χ2-test indicated that the differences in main mutation sites（Y181C, K103 N, V108 I, K101 E in NNRTIS coding region, M184V/I, M41 L, T215 F, T215 Y in NRTIs coding region and A71V/T, L10 I, M46 L, Q58 E in PIs coding region） were not statistically significant（P〈0.05） among the patients infected through three routes. The results of OR value and the 95% confidence interval（CI） indicated that age, infection routes, CD4＋ cell count and initial therapeutic plan had a significant relevance to HIV-1 drug resistance mutation（P〈0.05）. Conclusion Timely monitor of CD4＋cell number, viral load and drug resistance, and evaluation of progression of AIDS, are essential to minimize the influence of related factors on drug resistance, and to renew the therapeutic plan in time during HAART in order to enhance the therapeutic effects.

关 键 词：HIV 抗病毒药 突变 

分 类 号：R512.91[医药卫生—内科学]