湖南省2020年整合酶抑制剂治疗的艾滋病患者HIV耐药突变分析  

Analysis of drug resistant mutations among AIDS patients with integrase inhibitors in Hunan province in 2020

作　　者：梁梦然 邹潇白[2] 贺健梅[2] 陈曦[2] Liang Mengran;Zou Xiaobai;He Jianmei;Chen Xi(School of Public Health,University of South China,Hengyang 421001,China;Hunan Provincial Center for Disease Prevention and Control,Changsha 410005,China)

机构地区：[1]南华大学公共卫生学院,衡阳421001 [2]湖南省疾病预防控制中心,长沙410005

出　　处：《中华实验和临床病毒学杂志》2022年第1期92-96,共5页Chinese Journal of Experimental and Clinical Virology

基　　金：国家科技重大专项(2017ZX10201101-002-009)。

摘　　要：目的评估整合酶抑制剂(integrase inhibitors,INIs)抗病毒治疗效果,分析治疗失败患者的基因型耐药突变情况,为艾滋病临床治疗提供参考。方法采用回顾性研究,选取湖南省2020年使用INIs≥1年的患者为研究对象,对其中病毒抑制失败(病毒载量≥1000拷贝/ml)的患者采用In-house法进行基因型耐药检测。结果408例研究对象中,病毒抑制失败12例(2.9%)。获得有效序列12份,其中8份出现耐药突变。调查人群总耐药突变发生率为2.0%(8/408)。本研究发现1例(0.2%)对INIs耐药,突变位点为T66I、G118R、E138K;发现7例(1.7%)对核苷类逆转录酶抑制剂(nucleoside reverse transcriptase inhibitors,NRTIs)和5例(1.2%)对非核苷类逆转录酶抑制剂(non-nucleoside reverse transcriptase inhibitors,NNRTIs)耐药,主要突变位点分别为M184V/I、D67N和K103N;发现1例(0.2%)对蛋白酶抑制剂(protease inhibitors,PIs)耐药,突变位点为I50L。出现耐药突变的8例患者中,1例同时对INIs、NRTIs和NNRTIs 3类药物耐药,4例同时对2类药物耐药(3例NRTIs和NNRTIs、1例PIs和NNRTIs)。结论INIs药物耐药发生率较低,但提示要定期开展INIs耐药监测。Objective To provide data support for acquired immunodeficiency syndrome(AIDS)clinical treatment by evaluating the antiviral therapy effect of integrase inhibitors(INIs)and analyzing the drug resistant mutations.Methods Patients who exposed to INIs more than 1 year were analyzed retrospectively.Virus suppression failure subjects(viral load≥1000 copies/ml)were sequenced for drug resistance analysis.Results Of 408 patients,12 cases(2.9%)were virologic failure,8 cases had drug resistance mutations.The proportion of drug resistance was 2.0%(8/408).Among them,only 1 case(0.2%,1/408)was resistant to INIs with associated mutations:T66I,G118R and E138K;7 cases(1.7%,7/408)were resistant to nucleoside reverse transcriptase inhibitors(NRTIs)with major mutations:M184V/I,D67N for NRTIs;5 cases(1.2%,5/408)were resistant to non-nucleoside reverse transcriptase inhibitors(NNRTIs)with major mutation:K103N;1 case(0.2%,1/408)was resistant to protein inhibitors(PIs),and associated mutations was I50L.1 case was resistant simultaneously to INIs,NRTIs and NNRTIs,Dual-class mutations were observed in 4 cases(3 cases to NRTIs and NNRTIs,1 case to PIs and NNRTIs).Conclusions The study result showed that the drug resistance rate of INIs was low in Hunan province,however,the INIs drug resistance surveillance was necessary.

关 键 词：人类免疫缺陷病毒 获得性免疫缺陷综合征 整合酶抑制剂 耐药突变 抗逆转录病毒治疗 

分 类 号：R512.91[医药卫生—内科学]