不同时期抗病毒治疗对艾滋病患者耐药产生的影响分析  

HIV drug resistance and the impact of antiretroviral therapy initiated at different stages among AIDS patiens

作　　者：袁源[1] 司珩[1] 刘宏伟[1] 刘春华[1] 王哲[1] 阮玉华[2] 邢辉[2] 

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,河南郑州450016 [2]中国疾病预防控制中心性病艾滋病预防控制中心,北京102206

出　　处：《山东大学学报（医学版）》2016年第9期77-81,共5页Journal of Shandong University:Health Sciences

基　　金：河南省重点科技攻关计划(102102310003;112102310005)

摘　　要：目的比较不同时机开始抗病毒治疗对艾滋病患者耐药产生的影响。方法对河南省接受一线抗病毒治疗方案〉6个月的艾滋病患者进行横断面调查,根据基线免疫水平,将调查对象分为早期治疗组（CD4＋T淋巴细胞≥350个/mm3）132例、常规治疗组（CD4＋T淋巴细胞201个/mm3～349个/mm3）200例和延迟治疗组（CD4＋T淋巴细胞≤200个/mm3）329例。通过多因素Logistic回归,分析抗病毒治疗患者耐药发生的影响因素。结果共调查符合条件的抗病毒治疗患者661例,总耐药率为34.3%（227/661）,其中早期治疗组、常规治疗组和延迟治疗组出现耐药突变的比例分别为21.2%（28/132）、35.5%（71/200）和38.9%（128/329）。多因素Logistic回归分析显示,早期治疗（OR=0.31,95%CI 0.19～0.51,P〈0.001）、依从性高（OR=0.48,95%CI 0.30～0.78,P=0.003）和含3TC初始治疗方案（OR=0.20,95%CI 0.20～0.40,P〈0.001）是影响抗病毒治疗耐药产生的保护因素,治疗时间长（OR=1.90,95%CI 1.22～2.95,P=0.004 3）是影响抗病毒治疗耐药产生的危险因素。结论早期开始抗病毒治疗可减少抗病毒治疗患者耐药毒株的产生,能取得良好的抗病毒治疗效果。Objective To compare the impact of antiretroviral therapy initiated at different stages on drug resistance among AIDS patients. Methods AIDS patients treated with first-line HAART for 6 months in Henan Province were investigated with cross-sectional survey and blood samples were collected. According to the level of baseline immunology, the patients were divided into 3 groups： early treatment group （n = 132, CD4 ＋T cell counts ≥ 350 cel//mm3）, conventional treatment group （ n=200, 200 cell/mm3 〈 CD4 ＋ T cell counts 〈 350 cell/mm3 ） and delayed treatment group （n = 329, CD4 ＋ T cell counts ≤0 cell/ram3 ）. The factors associated with the development of HIV-1 drug resistance were analyzed with multivariate logistic regression. Results A total of 661 patients were investigated. The total prevalence of HIV-1 drug resistance was 34.3% （227/661）. The prevalence of drug resistance in the early treatment group, conventional treatment group and delayed treatment group was 21.2% （28/132）, 35.5% （71/200） and 38.9% （ 128/329）, respectively. Multivariate logistic regression analysis showed that the protective factors associated with the development of drug resistance included earlier treatment （ OR = 0.31, 95 % CI0.194）. 51, P 〈 0.001 ）, high compliance （OR=0.48, 95% CI0.30-0.78, P=0.003） and initiation of ART with 3TC （OR=0.20, 95% CI0.20- 0.40, P 〈0.001 ）, while long-duration of treatment （ OR = 1.90, 95% CI 1.22-2.95, P = 0. 004 3 ） was the risk factor. Conclusion Early initiation of antiretroviral therapy for AIDS patients receiving HAART could reduce the emergence of the drug resistant strains and acquire good effect.

关 键 词：艾滋病 早期抗病毒治疗 耐药 影响因素 

分 类 号：R183.9[医药卫生—流行病学]