2014年四川省部分地区HIV/AIDS患者抗病毒治疗效果和耐药性影响因素分析  

Influencing factors for therapeutic effect and drug resistance among HIV/aids patients receiving antiviral therapy in some areas of Sichuan,2014

作　　者：袁丹[1] 叶黎[1] 龚芳红[2] 罗德维[3] 杨红[4] 吴薇[5] 黄晓玲[6] 曾亚莉[1] 杨洪[1] 苏玲[1] 魏东兵[1] 梁姝[1] 刘红露[1] 

机构地区：[1]四川省疾病预防控制中心性病艾滋病预防控制所,四川成都610041 [2]成都市疾病预防控制中心微生物检验科,四川成都610041 [3]达州市疾病预防控制中心卫生检验中心,四川达州635000 [4]绵阳市疾病预防控制中心微生物检验所,四川绵阳621000 [5]乐山市疾病预防控制中心检验所,四川乐山614000 [6]宜宾市疾病预防控制中心检验科,四川宜宾644000

出　　处：《现代预防医学》2016年第13期2445-2452,共8页Modern Preventive Medicine

基　　金：2012年四川省卫生厅科研课题-彝汉族人群HIV耐药突变位点差异分析(120154)

摘　　要：目的了解成都、绵阳、达州、乐山和宜宾HIV/AIDS在治患者治疗效果和耐药性影响因素。方法 2014年对以上地区抗病毒治疗半年以上,年龄≥15岁的HIV/AIDS患者进行血浆HIV病毒载量(VL)及基因型耐药检测,采用统计学卡方检验及logistic回归分析治疗效果及病毒抑制失败患者耐药发生的影响因素,以及各亚型毒株间耐药突变规律。结果 4 087例符合调查标准,其中VL<400拷贝/ml 3534例(86.47%),VL>1 000拷贝/ml 510例(12.48%)。多因素logistic回归分析发现患者所在地区、年龄、传播途径及治疗时间对治疗效果的影响有统计学意义。VL>1 000拷贝/ml患者样本中,389例(76.27%)核酸扩增阳性并获得基因序列,189例(48.59%)发生耐药突变,主要导致核苷类逆转录酶抑制剂和非核苷类逆转录酶抑制剂耐药,多因素logistic回归分析初始治疗方案、治疗前CD4水平及感染CRF_01AE亚型毒株对耐药发生率的影响有统计学意义。耐药突变序列中,部分位点耐药突变率在CRF_01AE和CRF_07BC两种亚型毒株间差异具有统计学意义。结论四川省成都、绵阳、达州、乐山和宜宾地区HIV/AIDS患者中,地区、年龄、传播途径及治疗时间是治疗效果的影响因素;病毒抑制失败患者中,初始治疗方案、基线CD4水平及感染不同亚型毒株是耐药的因素影响;CRF_01AE和CRF_07BC亚型毒株比较,前者更易发生T69、M184、V75、Y181突变,而后者更易发生Q58、A71突变。Objective To probe into the influencing factors for therapeutic effect and drug resistance among HIV / AIDS patients receiving antiviral therapy in Chengdu,Mianyang,Dazhou,Leshan and Yibin. Methods In 2014,HIV virus load（ VL） in plasma and drug- resistant genotypes were studied among HIV / AIDS patients in these areas aged 15 years and above who had received antiviral therapy for more than 6 months. Chi- square test and logistic regression of statistics were employed to analyze the influencing factors for the therapeutic effect and for the development of drug resistance among patients failing viral suppression treatment,and also the pattern of drug- resistant mutations across different viral subtypes. Results There were4087 patients meeting the inclusion criteria. Among them,3534（ 86. 47%） had the VL 400 copies / ml and 510（ 12. 48%） had the VL 1000 copies / ml. It was found in multiple logistic regression analysis that the area where the patient was located,age,route of transmission and treatment duration had statistically significant influence on the therapeutic effect. Among the patients with VL 1000 copies / ml,389（ 76. 27%） were positive for HIV PCR,from whom the gene sequence was obtained,and 189（ 48. 59%） had drug- resistant mutations primarily to nucleoside reverse transcriptase inhibitors and non- nucleoside reverse transcriptase inhibitors. In multiple logistic regression analysis,initial treatment regimen,baseline CD4 level and infection with CRF_01AE subtype presented statistically significant influence on the incidence of drug resistance. With regard to the drug-resistant mutations,there were statistically significant differences between the CRF_01AE and CRF_07BC subtypes in the drug- resistant mutation rates at some loci. Conclusion Among the HIV / AIDS patients in Chengdu,Mianyang,Dazhou,Leshan and Yibin of Sichuan province,region,age,route of transmission and treatment duration were the influencing factors for the therapeutic effect; among the patients failing viral suppression

关 键 词：艾滋病 抗病毒治疗 亚型 耐药 

分 类 号：R184[医药卫生—流行病学]