2014年宜宾市HIV-1抗病毒治疗患者耐药情况及分析  

Drug Resistance in Patients on HIV-1 Antiviral Therapy in Yibin in 2014

作　　者：黄晓玲[1,2] 曾宏[2] 王晓燕[2] 袁丹[3] 刘红露[3] 王川勇 苏玲[3] 魏东兵[3] 叶黎[3] 许欣[1] 

机构地区：[1]四川大学华西公共卫生学院,成都610041 [2]宜宾市疾病预防控制中心,四川宜宾644000 [3]四川省疾病预防控制中心艾滋病确证中心实验室,成都610041

出　　处：《预防医学情报杂志》2017年第1期18-24,共7页Journal of Preventive Medicine Information

摘　　要：目的分析宜宾市2014年检测的HIV-1抗病毒治疗半年以上患者的耐药情况,为下一步抗病毒治疗提供依据。方法对宜宾市艾滋病抗病毒治疗半年以上的患者进行病毒载量检测,对病毒载量结果大于1 000 cps/ml的患者样本的核酸进行PCR和pol基因测序,所得结果登录美国斯坦福大学HIV耐药数据库进行在线分析确定耐药突变情况。结果447例治疗患者中186例(41.61%)小于病毒载量最低检测限,147例(32.89%)病毒载量结果大于1 000 cps/ml,47例(10.51%)出现不同程度耐药,其中有1例NRTIs出现不同程度耐药,12例NNRTIs出现不同程度耐药,34例对NRTIs和NNRTIs同时出现不同程度耐药(有2例对NRTIs、NNRTIs以及PIs同时耐药)。47例产生耐药的患者中,28例(59.58%)CRF_01AE亚型,7例(14.89%)CRF_08BC亚型,7例(14.89%)CRF_07BC亚型,2例(4.26%)C亚型,剩余3例(6.38%)分型情况不详。结论宜宾市HIV耐药毒株呈现中度流行态势,已出现耐药情况的患者中,交叉耐药的情况比较普遍,尤其是对NNRTIs的交叉耐药比较严重,部分患者对NRTIs和NNRTIs全部耐药,建议临床医生加强对患者服药督导,提高患者的依从性,并根据耐药情况酌情对患者调整治疗方案。Objective To analyze drug resistance in patients having accepted HIV - 1 antiviral therapy for more than half a year in Yibin in 2014 and provide reference for antiviral treatment in the future. Methods Viral loads were assayed in patients who have accepted HIV - 1 antiviral therapy for more than half a year in Yibin and PCR assay and pol gene sequencing of nucleic acids were conducted in patients with a viral load 〉 1 000 cps/ml. Stanford HIV Drug Resistance Database was logged in for online analysis of the obtained results to determine drug resistance mutations. Results Among 447 treated patients, viral loads of 186 （41.61%） were lower than the lowest detectable limit, and viral loads of 147 （32. 89%） were 〉1 000 cps/ml. 47 （10.51%） patients presented with different degrees of drug resistance, including one with different degrees of resistance to NR-TIs, 12 with different degrees of resistance to NNRTIs and 34 with different degrees of resistance to both NRTIs and NNRTIs （two patients were resistant to NRTIs, NNRTIs and also PIs）. Among the 47 drug - resistant patients, the virus were identified as subtype CRF_ 01AE in 28 （59.58%）, subtype CRF_ 08BC in 7 （ 14. 89% ）, subtype CRF_ 07BC in 7 （ 14.89% ） and subtype C in 2 （4. 26% ） and unknown in the other 3 （6. 38% ）. Conclusion In Yibin, drug-resistant HIV strains show a moderately prevalent trend; in patients with drug resistance, cross resistance is common and is particularly serious to NNRTIs; part patients are resist- ant to both NRTIs and NNRTIs. It is suggested clinical doctors enhance guidance on drug administration in patients, improving patient compliance and depending on drug resistance conditions, adjusting therapeutic regimens appropriately.

关 键 词：HIV-1 抗病毒治疗 耐药检测 依从性 病毒载量 

分 类 号：R512.91[医药卫生—内科学]