男男同性恋HIV耐药的Meta分析  

HIV resistance in men who have sex with men:a Meta-analysis

作　　者：杨琳[1,2] 许睿玮[1,2] 赵广录[2] 冯铁建[2] 胡平成[1] 

机构地区：[1]中南大学湘雅公共卫生学院流行病与卫生统计学系,长沙410078 [2]深圳市慢性病防治中心,深圳518021

出　　处：《中南大学学报（医学版）》2017年第6期695-705,共11页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(81271504)~~

摘　　要：目的:了解男男同性恋(men who have sex with men,MSM)艾滋病原发性耐药及耐药基因突变位点现状。方法:检索CNKI,VIP,CBM,万方数据库,Pub Med,Web of Knowledge,Springer及Medline数据库,提取HIV耐药以及耐药基因突变位点数据,对效应量进行合并,并对样本量、地区、人种、质量评价得分及采样时间进行亚组分析。结果:共纳入43篇文献,MSM未治疗HIV感染者总耐药率、蛋白酶抑制剂(proteinase inhibitors,PI)耐药率、核苷类反转录酶抑制剂(nucleoside reverse transcriptase inhibitors,NRTI)耐药率、非核苷类反转录酶抑制剂(non nucleoside reverse transcriptase inhibitors,NNRTI)耐药率分别为10.21%(95%CI:8.65%~12.03%),2.98%(95%CI:2.25%~3.93%),4.05%(95%CI:3.14%~5.21%),4.42%(95%CI:3.31%~5.88%)。PI主要突变位点、PI次要突变位点、NRTI突变位点、NNRTI突变位点的突变位点频数≥3的突变率分别为0.55%(95%CI:0.38%~0.80%),1.31%(95%CI:0.98%~1.75%),0.85%(95%CI:0.51%~1.40%),1.19%(95%CI:0.70%~2.01%);频数<3的突变率分别为0.79%(95%CI:0.55%~1.13%),1.73%(95%CI:1.21%~2.46%),0.86%(95%CI:0.61%~1.21%),2.24%(95%CI:1.77%~2.83%)。样本量、地区及人种均是异质性的来源,耐药率和基因突变位点突变率在不同的亚组中分布不同。结论:美洲、欧洲地区MSM原发性耐药率较高,亚洲地区较以往也有所升高;同时PI次要突变位点突变率亦较高,应引起重视。Objective：To assess the prevalence of HIV primary drug resistance and drug resistance gene mutations among men who have sex with men（MSM）.Methods：We searched eight electronic databases（CNKI,VIP,CBM,Wanfang Database,Pub Med,Web of Knowledge,Springer,Medline） for the studies of HIV drug resistance relevant to MSM.Drug resistance and drug resistance mutations data were pooled and analyzed according to statistical test of homogeneity.Subgroups were further divided according to sample size,location,race,quality rating score,sampling time.Results：Forty-three studies were included in this Meta-analysis.The pooled rate of total to protease inhibitor（PI）,nucleoside reverse transcriptase inhibitor（NRTI） or non-nucleoside reverse transcriptase inhibitor（NNRTI） were 10.21%（95% CI 8.65% to12.03%）,2.98%（95% CI 2.25% to 3.93%）,4.05%（95% CI 3.14% to 5.21%）,4.42%（95% CI 3.31% to 5.88%）,respectively.The pooled rates of PI major mutation,PI secondary mutations,NRTI mutations and NNRTI mutations were 0.55%（95% CI 0.38% to 0.80%）,1.31%（95% CI 0.98% to 1.75%）,0.85%（95% CI 0.51% to 1.40%）,1.19%（95% CI 0.70% to 2.01%）,0.79%（95% CI 0.55% to 1.13%）,1.73%（95% CI 1.21% to 2.46%）,0.86%（95% CI 0.61% to 1.21%）,2.24%（95% CI 1.77% to 2.83%）,respectively.Sample size,region,and race were heterogeneous sources;the rate of resistance mutations and gene mutation rate were different in different subgroups.Conclusion：The prevalence of primary drug resistance among MSM was high in Americas and Europe,and it was gradually increased in Asia.We should pay attention to the high incidence of PI secondary mutations.

关 键 词：艾滋病病毒 原发性耐药 耐药基因突变位点 男男同性恋 META分析 

分 类 号：R512.91[医药卫生—内科学]