四川省艾滋病抗病毒治疗6~12个月病毒学失败患者耐药性分析  

Drug resistance of patients with virologic failure in Sichuan after 6—12 months of AIDS antiretroviral therapy

作　　者：袁丹[1] 张燕 李一平 李玲 周玚 苏玲[1] 叶黎[1] 杨洪[1] 梁姝[1] YUAN Dan;ZHANG Yan;LI Yi-ping;LI Ling;ZHOU Chang;SU Ling;YE Li;YANG Hong;LIANG Shu(Sichuan Center for Disease Control and Prevention,Chengdu,Sichuan 610041,China)

机构地区：[1]四川省疾病预防控制中心,四川成都610041

出　　处：《现代预防医学》2021年第21期3967-3973,共7页Modern Preventive Medicine

基　　金：四川省卫生健康委员会科研课题(20PJ121)。

摘　　要：目的分析四川省接受艾滋病抗病毒治疗6~12个月病毒学失败患者的耐药影响因素和耐药特征。方法对2016—2019年接受治疗6~12个月且病毒学失败患者进行HIV-1基因型耐药检测,采用统计学logistic回归和卡方检验分析病毒学失败患者耐药发生的影响因素,以及不同地区和亚型毒株间耐药突变特征。结果3626例患者符合调查标准,成功获得序列2915例(80.39%),其中1246(42.74%)例耐药,多因素logistic回归分析发现,注射吸毒者的耐药突变是异性性传播患者的1.90倍;艾滋病的耐药突变是HIV感染者的1.75倍;基线CD4+T淋巴细胞计数≥350个/μl和200~349个/μl的耐药突变是CD4+T淋巴细胞计数<200个μl的0.76和0.64倍;初始治疗方案含洛匹那韦/利托那韦(LPV/r)的二线治疗方案的耐药突变是是含齐多夫定的0.37倍;感染CRF01_AE亚型毒株的耐药突变是感染CRF07_BC亚型毒株的1.34倍。成都平原、川东北、川西北、川南和攀西地区耐药率分别为45.41%、37.47%、54.84%、43.38和34.34%,卡方检验有统计学意义(P<0.05);主要流行亚型CRF07_BC、CRF01_E、CRF08_BC和CRF85_BC耐药率分别为39.60%、48.55%、34.17%和44.27%,卡方检验有统计学意义(P<0.05)。结论四川治疗6~12个月艾滋病患者病毒学失败的耐药率较高,耐药突变状况复杂多样,感染途径、基线CD4+T淋巴细胞计数、病程、感染毒株亚型、初始治疗方案是治疗6~12个月病毒学失败患者发生耐药的影响因素,且各地区耐药发生和各亚型耐药突变特征不同。Objective To analyze the resistance factors and drug resistance characteristics of people with HIV/AIDS who received antiviral therapy(ART)but failed in Sichuan province for 6-12 months.Methods The HIV-1 genotypic drug resistance was tested in patients with virus suppression failure who received antiviral therapy for 6-12 months from 2016 to 2019.The influencing factors of drug resistance were analyzed by statistical logistic regression and chi-square test,as well as the drug resistance mutation characteristics among different regions and subtypes.Results There were 3626 cases reaching the investigation criteria and 2915(80.39%)cases obtained the sequence successfully,of which 1246(42.74%)cases were tested as drug-resistant.Analysis of multivariate logistic regression showed that the OR value of drug-resistant mutation in IDUs was 1.90 compared with patients who were infected by taking drugs.And it was 1.75 compared with those infected with HIV.Compared with a baseline in which CD4+T lymphocyte count was less than 200/μl,the OR value were 0.76 and 0.64 respectively which CD4+T lymphocyte count was more than 350/μl and between 200-349/μl.Compared with the initial regimen containing zidovudine,the OR value of resistance mutation was 0.37 times of that using the second-line regimen containing lopinavir/ritonavir(LPV/R);The OR value of the Patients who infected with CRF07_BCstrain were 1.34 times the patients who were infected with CRF01_AE strain.The drug resistance rates were 45.41%,37.47%,54.84%,43.38%,and 34.34%in Chengdu Plain,Northeast Sichuan,Northwest Sichuan,South Sichuan,and Panxi,respectively,with statistical significance by chi-square test(P<0.05);The Main epidemic subtypes were CRF07_BC、CRF01_AE、CRF08_BC and CRF85_BC recombinant in Sichuan,and the drug resistance rates were 39.60%,48.55%,34.17%,and 44.27%respectively,with statistical significance by chi-square test(P<0.05).Conclusion The drug resistance rate of virus suppression failure in patients treated for 6-12 months in Sichuan is quite high,

关 键 词：HIV 艾滋病 抗病毒治疗 耐药突变 

分 类 号：R512.91[医药卫生—内科学]