河南省某县获得性免疫缺陷综合征患者二线抗病毒疗效及耐药变异分析  

Effect and drug resistance variation of second-line antiretroviral therapy among patients with acquired immune deficiency syndrome in a county of Henan Province

作　　者：尚明全 张旻[1] 尚红[1] Shang Mingquan;Zhang Min;Shang Hong(Key Laboratory of AIDS Immunology of National Health and Family Planning Commission,Department of Laboratory Medicine, the First Affiliated Hospital of China Medical University, Shenyang 110001, China;Clinical Laboratory, Chifeng Municipal Hospital, Chifeng 024000, China)

机构地区：[1]中国医科大学附属第一医院检验科卫计委艾滋病免疫学重点实验室,沈阳市110001 [2]内蒙赤峰市医院检验科,赤峰市024000

出　　处：《中华实验和临床感染病杂志（电子版）》2017年第4期330-334,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：国家科技重大专项资助(No.2008ZX10102)

摘　　要：目的了解我国河南省尉氏县部分获得性免疫缺陷综合征(AIDS)患者在更换二线抗病毒治疗方案后的疗效及耐药情况,并分析可能影响二线方案疗效的相关因素。方法对65例AIDS患者在换药前、二线方案治疗6个月、治疗12个月时分别进行随访调查,并分别行CD_4^+T细胞、病毒载量及耐药情况检测。结果队列中65例AIDS患者,经二线方案治疗12个月后,CD_4^+T细胞的均值与基线相比显著升高(t=-2.417、P=0.017),病毒载量均值显著降低(t=2.343、P=0.021),病毒载量<400拷贝/ml患者由换药前的6.2%上升至62.3%(χ2=42.704、P<0.001)。换药前患者交叉耐药和多药耐药严重,二线方案治疗12个月后,检出耐药患者比例由换药前78.5%(51/65)下降为11.3%(6/53);更换二线方案治疗前后均未检测到蛋白酶抑制剂(PI)耐药患者。换药前患者CD_4^+T<100个/μl和HIV-1 RNA>10 000拷贝/ml与治疗后病毒载量未能有效抑制相关(OR=5.14,95%CI:0.99~26.71;OR=3.36,95%CI:0.66~17.21)。结论二线抗病毒方案疗效显著。更换二线方案前后均未发现PI耐药,但检出大量蛋白酶抑制剂次要变异,应对更换二线抗病毒治疗方案患者进行长期的耐药监测。Objective To investigate the efficacy and drug resistance of patients with acquired immune deficiency syndrome(AIDS)in Weishi County of Henan province after the change of second-line antiviral therapy,and to analyze the factors which affect the efficacy of second-line therapy.Methods Total of65patients with AIDS were followed up before treatment change,6months and12months after secondline antiviral therapy.The CD4+T cell counts,viral load and genotypic resistance testing were detected,respectively.Results Among the cohort of65patients with AIDS,treatment for12months after the secondline,the mean CD4+T cell significantly increased compared with the baseline(t=-2.417,P=0.017),the mean viral load decreased significantly(t=2.343,P=0.021),and patients of viral load<400copies/ml increased from6.2%to62.3%(χ2=42.704,P<0.001).Cross resistance and multi-drug resistance were severe in patients with baseline.After12months of second-line treatment,the proportion of resistant patients was decreased from78.5%(51/65)to11.3%(6/53);protease inhibitor(PI)resistant patients weren't detected before and after treatment with second-line regimens.Before the change of dressing,patients with CD4+T<100cells/μl and HIV-1RNA>10000copies/ml were significantly related to virologic failure(OR=5.14,95%CI=0.99-26.71;OR=3.36,95%CI=0.66-17.21).Conclusions The second-line antiretroviral therapy was effective.PI drug resistance wasn't found before and after the secondline regimens was replaced.However,a large number of minor protease inhibitors mutations were detected.Long-term resistance surveillance should be carried out in patients with second-line antiretroviral therapy.

关 键 词：获得性免疫缺陷综合征 高效抗逆转录病毒治疗 耐药 二线治疗方案 

分 类 号：R512.91[医药卫生—内科学]