北京地区HIV-1感染者治疗前耐药特征及2年抗病毒治疗效果研究  

Characteristics of pretreatment drug resistance in HIV-1 infected patients in Beijing and the efficacy of two-year antiretroviral therapy

作　　者：孙伟东[1] 姜天俊 黄辉煌 李佳[1] 陈婧[1] 邢辉[3] 李洁[1] 卢红艳[1] 黄春[1] 辛若雷[1] Sun Weidong;Jiang Tianjun;Huang Huihuang;Li Jia;Chen Jing;Xing Hui;Li Jie;Lu Hongyan;Huang Chun;Xin Ruolei(Institute for STD/AIDS Prevention and Control,Beijing Municipal Center for Disease Prevention and Control,Beijing Research Center for Preventive Medicine,Beijing 100013,China;Center for Infectious Disease Diagnosis and Therapy,Fifth Medical Center of PLA General Hospital,Beijing 100039,China;Department of Virology and Immunology,National Center for AIDS/STD Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China)

机构地区：[1]北京市疾病预防控制中心,北京市预防医学研究中心性病艾滋病防治所,100013 [2]解放军总医院第五医学中心感染性疾病诊疗与研究中心,北京100039 [3]中国疾病预防控制中心性病艾滋病预防控制中心病毒及免疫研究室,北京102206

出　　处：《国际病毒学杂志》2020年第3期224-227,共4页International Journal of Virology

基　　金：北京市自然科学基金资助项目(7202074);北京市科学技术委员会资助项目(D161100000416002)。

摘　　要：目的了解北京地区HIV-1感染者治疗前耐药特征及其对抗病毒治疗效果影响。方法对初始治疗病例进行基线和随访耐药检测,使用斯坦福大学HIV耐药数据库解释获得的pol基因片段序列,分析治疗前或获得性耐药特征。结果共获得325例(97.9%)治疗前pol基因片段。主要流行毒株为CRF01_AE(49.4%),CRF07_BC(27.1%)和B亚型(5.4%);新发重组毒株占9.9%。11例(3.4%)携带治疗前耐药突变,其中1例发展为获得性耐药。2年治疗过程中11例(3.3%)出现病毒抑制失败,10例存在耐药相关突变,其治疗前CD4细胞计数低于200个/µL。结论北京地区HIV-1治疗前耐药发生率较低,且对一线方案治疗影响较小。艾滋病期病例容易发生耐药导致治疗失败。及时动员治疗,加强治疗后耐药监测,维持持续病毒抑制治疗效果。Objective To understand the genetic characteristics of pretreatment drug resistance(PDR)among HIV-1 infected patients in Beijing,and its impact on antiretroviral therapy(ART).Methods Baseline and follow-up tests for drug resistance were applied for HIV-1 infected patients receiving initial treatment.The obtained HIV-1 pol gene segments were interpreted by Stanford University HIV Drug Resistance Database for PDR and acquired drug resistance(ADR),respectively.Results A total of 325(97.9%)HIV-1 pol gene segments from ART-naïve cases were obtained.CRF01_AE was the dominant strain,accounting for 49.4%,followed by CRF07_BC(27.1%)and subtype B(5.4%).Unique recombinant forms accounted for 9.9%.Eleven cases(3.4%)carried PDR and one case finally developed ADR.During the two-year’s follow-up,11 cases(3.3%)showed virus suppression failure,including 10 cases carrying drug resistance-associated mutations with CD4 cell count below 200 cells/µL before treatment.Conclusions The prevalence of HIV-1 PDR was low in Beijing and a minor impact was conveyed by PDR on the efficacy of first-line ART regimens.AIDS cases were inclined to develop virological failure.Timely motivation of treatment and surveillance on drug resistance after treatment should be reinforced to increase the sustained viral s uppression.

关 键 词：人免疫缺陷病毒 治疗前耐药 抗病毒治疗 病毒抑制 获得性耐药 

分 类 号：R512.91[医药卫生—内科学]