安徽省宿州市艾滋病抗病毒治疗效果评估及治疗失败病例耐药分析  

Evaluation on antiretroviral treatment efficacy for AIDS and analysis of drug resistance in patients with treatment failure in Suzhou city, Anhui province

作　　者：胡雪影[1] 张玲[1] 邱山[1] 吴建军[2] Hu Xueying;Zhang Ling;Qiu Shan;Wu Jianjun(Suzhou Center for Diseases Control and Prevention,Suzhou 234000,China;Anhui Provincial Center for Diseases Control and Prevention,Hefei 230601,China)

机构地区：[1]安徽省宿州市疾病预防控制中心检验科,234000 [2]安徽省疾病预防控制中心艾滋病防治科,合肥230601

出　　处：《国际病毒学杂志》2020年第5期421-424,共4页International Journal of Virology

摘　　要：目的评估安徽省宿州市艾滋病抗病毒治疗效果,分析治疗失败患者的基因型耐药情况,为调整治疗方案提供科学依据。方法对宿州市2019年第四季度正在治疗的1060例艾滋病患者进行随访,检测其CD4+T淋巴细胞计数和HIV-1病毒载量(viral load,VL),并对VL>1000 cps/mL的患者进行基因型耐药检测。结果1060例患者最近一次CD4^+T淋巴细胞计数较初始治疗前显著升高(t=-31.014,P<0.01));HIV-1病毒抑制率(VL<1000 cps/mL)为93.4%(990/1060),VL>1000 cps/mL的患者耐药率为49.3%(33/67);针对非核苷类反转录酶抑制剂(non-nucleoside reverse transcriptase inhibitor,NNRTI)、核苷类反转录酶抑制剂(nucleoside reverse transcriptase inhibitor,NRTI)和蛋白酶抑制剂(protease inhibitor,PI)耐药突变率分别为44.8%(30/67)、20.9%(14/67)和4.5%(3/67);突变频率最高的位点是M184、K103和V106,均为17.9%(12/67),同时耐NRTI和NNRTI的双重耐药突变达19.4%(13/67),并出现1例同时耐PI、NRTI和NNRTI的多重耐药突变,耐药以3TC/FTC/NVP/EFV为主。结论宿州市抗病毒治疗后病毒抑制率较高,但治疗失败人群耐药率较高,且出现多重耐药,建议及时进行病毒载量和基因型耐药检测,为调整治疗方案提供科学依据。Objective To evaluatee the efficacy of antiviral therapy for AIDS in Suzhou city,and to analyze the genotype resistance of patients with treatment failure,so as to provide scientific basis for the adjustment of antiviral therapy.Methods A total of 1060 HIV/AIDS patients receiving treatment in the fourth quarter of 2019 in Suzhou city were followed.The CD4^+T-lymphocytes and HIV-1 viral load were detected.Genotype resistance of samples with VL>1000 cps/ml was detected.Results The mean CD4+T-lymphocytes counts were significantly higher than those before the initial treatment(t=-31.014,P<0.001).The viral suppression rate of HIV-1(VL<1000 cps/ml)was 93.4%(990/1060),and the drug resistance rate of patients with VL>1000 cps/ml was 49.3%(33/67).The proportion of drug-resistant mutations in non-nucleoside reverse transcriptase inhibitor(NNRTI),nucleoside reverse transcriptase inhibitor(NRTI)and protease inhibitor(PI)were 44.8%(30/67),20.9%(14/67)and 4.5%(3/67),respectively.The sites with the highest mutation frequency were M184,K103 and V106(all were 17.9%.12/67).The proportion of dual drug resistant mutations to NRTI and NNRTI was 19.4%(13/67),and there was a case of multi-drug resistance mutation to PI,NRTI and NNRTI.Resistance was mainly 3TC/FTC/NVP/EFV.Conclusions The viral suppression rate of HIV/AIDS was high after antiretroviral treatment in Suzhou city.But drug resistance was common among patients with treatment failure and multi-resistance case was also found.It is recommended to detect timely the viral load and genotype resistance to provide a scientific basis for the adjustment of treatment plan.

关 键 词：艾滋病 抗病毒治疗 基因型耐药 

分 类 号：R512.91[医药卫生—内科学]