上海地区艾滋病病毒感染者/艾滋病患者原发性耐药基因调查及抗病毒治疗效果观察  

Observation of HIV primary drug resistance effect of highly active antiretroviral therapy in Shanghai

作　　者：盖晶[1] 吴健[2] 王绪琴[1] 宿飞[2] 陶静[3] 郁晓磊 郑敏[4] 周艳秋[5] 周鑫[1] 薛以乐[1] 康来仪[1] 

机构地区：[1]上海市疾病预防控制中心,上海200336 [2]上海市黄浦区疾病预防控制中心,上海200023 [3]上海市虹口区疾病预防控制中心,上海200082 [4]上海市长宁区疾病预防控制中心,上海200051 [5]上海市静安区疾病预防控制中心,上海200041

出　　处：《疾病监测》2017年第2期162-167,共6页Disease Surveillance

基　　金：国家重大科技专项(No.2012ZX10001-002-002-012)~~

摘　　要：目的了解上海地区伴有HIV-1原发性耐药的艾滋病病毒感染者/艾滋病患者(HIV/AIDS)对高效抗反转录病毒治疗(HAART)效果的影响,评估长期抗病毒治疗方案,为调整治疗策略提供依据。方法从上海市艾滋病治疗数据库中随机选取2007-2013年期间被诊断为HIV-1的感染者,在未治疗前进行原发性耐药检测。对其中原发性耐药的病例进行1~7年不等的随访检测,通过CD4+T淋巴细胞计数及病毒载量结果评估抗病毒治疗效果。结果 1 543例HIV-1感染者中发现HIV原发性耐药42例,其中失访8例,死亡1例,停药1例,最后获得32例原发性耐药者。32例中非核苷类反转录酶抑制剂(NNRTI)耐药相关突变11例,核苷类反转录酶抑制剂(NRTI)耐药相关突变7例,蛋白酶抑制剂(PI)耐药相关突变6例;对NRTIs和NNRTIs同时耐药突变有3例,同时发生对PIs和NNRTIs的耐药相关突变1例,同时发生对PIs和NRTIs的耐药相关突变2例;对整合酶抑制剂(IN)耐药相关突变2例,平均原发性耐药率为2.7%。随访监测CD4+T淋巴细胞计数和病毒载量变化结果显示,32例患者的CD4+T淋巴细胞数量在HAART治疗前和治疗后的0.5、1、2、3、4、5、6和7年(±1个月)时分别为249.5±157.4、304.9±188.7、356.3±206.4、441.4±245.7、455.4±256.8、453.2±168.5、458.2±202.4、454.0±66.8和432.0±100.4个/$l。服药依从性指标评估显示所有病例均每年检测病毒载量,除了2例病例病毒载量为600拷贝/ml和700拷贝/ml外,其余病毒载量检测均低于检测下限,病毒抑制率为100%。上述病例在随访期间,均因毒副反应而更换为其他一线药物或二线药物。结论通过随访观察上海地区伴原发性耐药的HIV/AIDS对抗病毒的治疗效果,在原发性耐药率低的流行地区,如果治疗管理规范,患者服药依从性好,并经常开展公共卫生原发性耐药监测,在条件有限的情况下可不考虑进行治疗前原发性耐药检测。Objective To observe the effect of highly active antiretroviral therapy（ HAART） on HIV-positive subjects with primary drug-resistant in Shanghai,and to assess the effects of the long-term HAART for the improvement of treatment strategies in the future. Methods Untreated HIV-infected individuals were randomly selected from Shanghai AIDS treatment database from 2007 to 2013. Plasma samples of selected individuals were tested for primary drug resistance. Individuals with primary drug resistance were followed up for 1 to 7 years. The treatment effect was measured by CD4^＋count and viral load test. Results Of1 543 untreated HIV- 1 infected individuals,42（ 2. 7%） were found to have primary drug-resistance. Among 42 cases,8 werelost to follow-up,1 died and 1 stopped taking medicine. Except for these 10 individuals,32 cases were selected for our research.Non-nuclear nucleoside reverse transcriptase inhibitor（ NNRTI） resistance mutations occurred in 11 of 32 cases（ 34. 4%）,nucleoside reverse transcriptase inhibitor（ NRTI） resistance mutations in 7 cases（ 21. 9%）,protease inhibitor（ PI） resistance mutations in 6 cases（ 18. 6%）. There were 3 co-resistance mutations（ NRTI / NNRTI）. There were 3 co-resistance mutations（ 1 NNRTI/PI mutation,2 NRTI/PI mutations）. Integrase inhibitor（ IN） resistance mutations in 2 cases（ 6. 3%）. During the follow-up of 32 HIV-positive patients,the CD4^＋T cell counts were 249. 5 ± 157. 4,304. 9 ± 188. 7,356. 3 ± 206. 4,441. 4 ±245. 7,455. 4 ± 256. 8,453. 2 ± 168. 5,458. 2 ± 202. 4,454. 0 ± 66. 8 and 432. 0 ± 100. 4 /μl respectively before and 6 months,1 year,2 years,3 years,4 years,5 years,6 and 7 years（ ± 1 months） after HAART treatment. M edication adherence showed an extremely effective viral inhibition,30（ 93. 8%） cases showed no detectable viral load in the plasma,except for two cases showing an imperfect viral inhibition（ 600 and 700 copies / ml）,who exchanged the first-line or second-line therapy regimens with other

关 键 词：艾滋病病毒感染者/艾滋病患者 原发性耐药 高效抗反转录病毒治疗 随访 长期治疗 

分 类 号：R512.91[医药卫生—内科学]