云南省人类免疫缺陷病毒-1感染儿童长期抗病毒治疗疗效与基因型耐药特征分析  

Long-term efficacy evaluation of antiretrovirai therapy and genotypic resistance analysis among human immunodeficiency virus 1-infected children in Yunnan

作　　者：杨壁珲 张米 刘家发 李健健 楼金成 谢祺 汪习成 

机构地区：[1]云南省传染病专科医院检验科,昆明650301

出　　处：《中华传染病杂志》2017年第12期739-742,共4页Chinese Journal of Infectious Diseases

摘　　要：目的了解云南省HIV-1感染儿童长期抗病毒治疗后的疗效及耐药特征情况。 方法通过回顾性研究，分析2004年1月至2015年7月接受抗病毒治疗的HIV-1感染儿童的CD4＋ T淋巴细胞计数和病毒载量及基因型耐药检测数据。 结果共1 078例人类免疫缺陷病毒感染和（或）艾滋病（HIV/AIDS）儿童接受抗病毒治疗，治疗前CD4＋ T淋巴细胞计数为（466.8±397.2）个/μL，治疗1、3、5、8年分别有54.3%、62.9%、68.5%和74.2%的HIV/AIDS儿童CD4＋ T淋巴计数〉750个/L。150例（13.9%）HIV/AIDS儿童发生病毒学失败，病毒学失败发病密度为4.3/100人年。在治疗失败的150例患儿中104例检测出耐药突变，耐药突变率为69.33%。耐药突变位点主要为M184V/I[75.0%（78/104）]、K103N[43.3（45/104）]、G190A[29.8%（31/104）]、Y181C[22.1%（23/104）]和T215Y/F[20.2%（21/104）]。 结论我国儿童长期抗病毒后免疫恢复良好，病毒复制得到有效的抑制。HIV耐药是病毒学失败的主要原因，耐药突变主要发生在核苷反转录酶抑制剂和非核苷反转录酶抑制剂，对蛋白酶抑制剂耐药率低，及时进行耐药检测并更换二线治疗获得良好的治疗效果。ObjectiveTo evaluate the long-term efficacy of antiretroviral therapy and drug resistance among human immunodeficiency virus-1 （HIV-1）-infected children in Yunnan. MethodsIn this retrospective study, CD4＋ T cell counts, HIV viral loads and genetic drug resistance results were obtained from HIV-1-infected children who were treated with antiretroviral treatment between January 2004 to July 2015. ResultsA total of 1 078 HIV/acquired immune deficiency syndrome （AIDS） children were treated with antiviral therapy. Before treatment, the average CD4＋ cell number was （466.8±397.2） cells/μL. The percentages of children with CD4＋ cell count 〉750 cells/μL after 1-year, 3-year, 5-year and 8-year treatment were 54.31%, 62.87%, 68.46% and 74.19%, respectively. Virological failure occurred in 150 HIV/AIDS children （13.9%）, and the virological failure rate was 4.3/100 child-years. Among those 150 patients with virological failure, 104 cases （69.33%） exhibited genetic resistance to antiretroviral drugs. The prevalent mutations associated with drug resistance were M184V/I （75.0% [78/104]）, K103N （43.3% [45/104]）, G190A （29.8% [31/104]）, Y181C （22.1% [23/104]）, T215Y/F （20.2% [21/104]）. ConclusionsAfter long-term antiretroviral treatment, most of the HIV-infected children have restored the immunity and suppressed HIV viral replication successfully. HIV resistance is the main cause of virological failure. Drug resistance mutations mainly occur in nucleoside reverse transcriptase inhibitor and non-nucleoside reverse transcriptase inhibitor, and the resistance rate of proteinase inhibitor is low. Early genetic resistance testing and switch to second-line therapy will improve the treatment outcome.

关 键 词：儿童 治疗结果 抗药性 艾滋病抗病毒治疗 

分 类 号：R725.1[医药卫生—儿科]