广西桂南地区抗病毒治疗艾滋病患者耐药特征及影响因素分析  

The drug resistance characteristics and influencing factors of AIDS patients receiving antiretroviral therapy in south of Guangxi

作　　者：卢焕 吴念宁[1] 欧汝志[1] 李雪琴[1] 黎彦君[1] 吴锋耀[1] LU Huan;WU Nian-ning;OU Ru-zhi;LI Xue-qin;LI Yan-jun;WU Feng-yao(Deparment,the Fourth People′s Hospital of Nanning City(Guangxi AIDS Clinical Treatment Center),Nanning 530023,Guangxi,China)

机构地区：[1]南宁市第四人民医院(广西艾滋病临床诊疗中心)感染科,广西南宁530023

出　　处：《广东医学》2022年第1期98-102,共5页Guangdong Medical Journal

基　　金：南宁市科学研究与技术开发计划重大专项(20193008)。

摘　　要：目的了解广西桂南地区艾滋病毒感染或艾滋病(HIV/AIDS)患者免费抗反转录病毒治疗(ART)病毒抑制失败的耐药特征及影响因素,为HIV/AIDS患者临床治疗提供参考依据。方法横断面分析行免费抗病毒治疗的HIV/AIDS患者,根据纳入标准筛选研究对象,采用描述分析、χ^(2)检验分析研究对象病毒学抑制失败和耐药特征,用二项logistic回归分析耐药影响因素。结果1470例接受免费ART治疗HIV/AIDS患者中,137例(9.32%)病毒学抑制失败。病毒学抑制失败患者经耐药检测,有75例(54.74%)显示耐药,以NRTI(40.15%,55/137)和NNRTI耐药(51.82%,71/137)为主,同时发生NRTI和NNRTI耐药率为35.77%(49/137);1例显示对3种(NRTI、NNRTI和PI)药物耐药(0.73%,1/137)。NRTI耐药位点以M184V/I、K65R、T69S/N/A为主,分别占31.25%、21.88%和21.09%。NNRTI耐药位点以K103N/R/S、G190S/A/C/Q、V179D/E为主,分别占19.16%、16.77%、13.17%;PI耐药位点以L10I、L10V为主,分别占42.86%、21.43%。经χ^(2)检验和二项logistic归回分析:CD4^(+)T≥200个/μL、初始ART方案含LPV/r是耐药发生的保护因素。结论广西桂南地区HIV/AIDS患者ART后发生病毒学抑制失败率约10%,耐药是病毒抑制失败主要因素,主要以NRTIs和NNRTIs耐药为主,高CD4^(+)T细胞基线水平和含LPV/r治疗方案可以减少耐药的发生。Objective To analyze the drug resistance characteristics and influencing factors of HIV/AIDS patients who had virological suppression failure after receiving antiretroviral therapy(ART) in south of Guangxi, and to provide the evidence for clinical treatment of HIV/AIDS patients. Methods A cross-sectional analysis was carried on the HIV/AIDS patients who received free ART. The participants were selected under the inclusion criteria. Descriptive analysis and Chi square test were used to analyze the characteristics of virological inhibition failure and drug resistance. The influencing factors of drug resistance were analyzed by logistic regression. Results There were 1 470 HIV/AIDS patients received ART, and 137(9.32%) of them failed in virological suppression. Among these 137 patients, 75 cases(54.74%) showed drug resistance by drug resistance testing, and NRTI(40.15%, 55/137) and NNRTI(51.82%, 71/137) were the main resistant drugs. The rate of resistance to both NRTI and NNRTI was 35.77%(49/137), while only one patient(0.73%) was resistance to three drugs(NRTI, NNRTI and PI). The resistance sites of NRTI were mainly M184 V/I, K65 R and T69 S/N/A, accounting for 31.25%, 21.88% and 21.09%, respectively. K103 N/R/S, G190 S/A/C/Q and V179 D/E were the main resistance sites of NNRTI, accounting for 19.16%, 16.77% and 13.17%, respectively. L10 I and L10 V were the main resistance sites of PI, accounting for 42.86% and 21.43%, respectively. Chi square test and logistic regression analysis showed that CD4^(+) T counts≥ 200 cells/μL and initial ART regimen containing LPV/r were protective factors of drug resistance. Conclusion The failure rate of virological inhibition of HIV/AIDS patients after ART is approximately 10% in south of Guangxi. Drug resistance is the main reasons of failure treatment, with the main resistance drugs are NRTIs and NNRTIs. High baseline level of CD4^(+) T counts and initial ART regimen containing LPV/r can reduce the rate of resistance.

关 键 词：艾滋病 抗逆转录病毒治疗 病毒抑制失败 耐药 

分 类 号：R512.91[医药卫生—内科学] R978.7[医药卫生—临床医学]