自贡市HIV抗病毒治疗效果及耐药情况分析  

Analysis on the Effect and Drug Resistance of HIV Antiviral Therapy in Zigong City

作　　者：何晓冬[1] 袁丹[2] 陈燕梅[1] 万晓宇 张英[1] HE Xiaodong;YUAN Dan;CHEN Yanmei;WAN Xiaoyu;ZHANG Ying(Zigong Center for Disease Prevention and Control, Zigong 643000, Sichuan Province, China;Sichuan Center for Disease Prevention and Control, Chengdu 610041, Sichuan Province, China)

机构地区：[1]自贡市疾病预防控制中心,四川自贡643000 [2]四川省疾病预防控制中心,成都610041

出　　处：《预防医学情报杂志》2019年第7期739-745,共7页Journal of Preventive Medicine Information

摘　　要：目的分析2016年自贡市HIV抗病毒治疗效果及耐药情况。方法选取2016年自贡市接受HIV抗病毒治疗6个月以上病例1 258例,进行病毒载量检测,对病毒载量>1 000 cps/ml的样本进行耐药检测分析。结果 1 258例患者中,病毒载量>1 000 cps/ml有89例,病毒抑制失败率7.07%(89/1 258);病毒载量<400 cps/ml有1 144例,抗病毒治疗有效率90.94%(1 144/1 258);除去5例既往病例,有39例出现不同程度的耐药,耐药率3.10%(39/1 258),病毒抑制失败耐药率46.43%(39/84);39例耐药样本中,38例(97.43%)对非核苷类反转录酶抑制剂(NNRTIs)耐药,30例(76.92%)对核苷类反转录酶抑制剂(NRTIs)耐药,2(5.13%)例对蛋白酶抑制剂(PIs)耐药;耐药毒株对NRTIs主要突变位点为M184V/I/MV、K65R/KR,对NNRTIs主要突变位点主要为K103KN/N、Y181C/CY/YF、G190A/S/C/GA、V179T/E/VD/D,对PIs主要突变位点为V82A,次要突变位点主要为K20R、Q58E;耐药突变毒株,以CRF01_AE亚型和CRF07_BC亚型为主。结论自贡市2016年HIV抗病毒治疗效果较好,病毒抑制失败率和耐药率相对较低,但对NNRTIs耐药程度高,交叉耐药占比也较高,还出现1例对3类药物耐药病例。随着抗病毒治疗病人的不断增加,应重视耐药性监测工作,并及时评估治疗效果及耐药情况,同时应提高患者依从性教育,减少耐药株的产生和传播。Objective To analyze the HIV antiviral treatment effect and drug resistance of HIV/AIDS patients in Zigong in 2016. Methods In 2016,1 258 cases who had received HIV antiviral treatment for more than 6 months in Zigong city were selected for viral load test. Drug resistance analysis was performed on samples with viral load >1 000 cps/ml. Results Among the 1 258 patients,there were 89 patients with viral load >1 000 cps/ml, and the failure rate of virus suppression was7.07%(89/1 258). There were 1 144 cases with viral load<400 cps/ml, and the effective rate of antiviral therapy was 90.94%(1 144/1 258).Five cases with viral load >1 000 cps/ml were excluded due to negative amplification. There were 39 cases with varying degrees of drug resistance, and the drug resistance rate was3.10%(39/1 258). The drug resistance rate of samples with virus suppression failure was 46.43%(39/84). Among the 39 drug resistant samples,38(97.43%) were resistant to non-nucleoside reverse transcriptase inhibitors(NNRTIs),30(76.92%)were resistant to nucleoside reverse transcriptase inhibitors(NRTIs),and 2(5.13%) were resistant to protease inhibitors(PIs). M184 V/I/MV and K65 R/KR were the main mutation sites of the drugresistant strain for NRTIs. The main mutation sites for NNRTIs were K103 KN/N, Y181 C/CY/YF,G190 A/S/C/GA and V179 T/E/VD/D. For PIs, the main mutation site was V82 A, the secondary mutation sites were K20 R and Q58 E. Drug-resistant mutant strains were mainly CRF01_AE subtype and CRF07_BC subtype. Conclusion In 2016, the antiviral effect of HIV-1 in Zigong was generally good,the failure rate and drug resistance rate of viral inhibition were relatively low,but the degree of resistance to NNRTIs was high, and the proportion of cross-resistance was also high. Notably, there was one case of drug resistance to three types of drugs. With the increasing number of patients receiving antiviral therapy, more attention should be paid to drug resistance monitoring, the treatment effect and drug resistance should be evaluated in time. Me

关 键 词：HIV 病毒载量 抗病毒治疗 耐药 

分 类 号：R512.91[医药卫生—内科学]