抗病毒治疗失败的HIV感染/AIDS患者基因型耐药特征分析  

Analysis of genotype drug resistance in HIV/AIDS patients who failed antiviral therapy

作　　者：周明 黄丽花 龚世江 黄葵 Zhou Ming;Huang Lihua;Gong Shijiang;Huang Kui(Infectious Disease Department,Guangxi Zhuang Autonomous Region Chest Hospital,Guangxi Liuzhou 545002,China)

机构地区：[1]广西壮族自治区胸科医院感染科,广西柳州545002

出　　处：《新发传染病电子杂志》2022年第3期37-40,共4页Electronic Journal of Emerging Infectious Diseases

基　　金：广西卫健委自筹经费科研课题(Z20190638);柳州市农业农村与社会发展类科技计划项目(2020NBAD0803)。

摘　　要：目的分析广西柳州地区HIV-1高效抗反转录病毒治疗(HAART)患者中病毒抑制失败者的耐药基因突变特征,监测耐药发生并为评估抗病毒治疗效果提供依据。方法采用回顾性队列研究方法采集广西壮族自治区胸科医院一线抗病毒治疗时间超过12个月,病毒载量>1000copies/ml的HIV患者血浆标本308例,进行基因型耐药检测,分析耐药检测特征。结果共纳入308例患者,成功检测并获得288例基因序列,毒株亚型以CRF01_AE为主,总耐药率达到40.63%(117/288),耐药基因突变发生率57.29%(165/288),核苷类逆转录酶抑制剂(NRTIs)相关的突变位点主要为M184V、D67N和K65R;非核苷类逆转录酶抑制剂(NNRTIs)相关的突变位点则为K103N、G190A、Y181C和V179D;蛋白酶抑制剂(PIs)突变位点以L10I、L10V和A71V为主。结论广西柳州地区HAART失败人群中HIV-1基因型耐药比例高,需要加强耐药监测,了解耐药突变位点之间的相互作用,熟悉抗反转录病毒药物之间的耐药和交叉耐药模式的存在,有利于为患者提供精准有效的一线治疗方案,延迟二线药物的使用。Objective Analyzing drug resistant gene mutation of patients accept HIV-1 anti-viral treatment(HAART)in Liuzhou,Guangxi,monitoring occurrence of drug resistance to provide a basis for evaluating the effect of anti-viral treatment.Method We conduct a retrospective cohort study is conducted to collect blood samples of patients suffering from HIV in Liuzhou,Guangxi,who have a first-line anti-viral treatment time of more than 12 months and viral load of>1000 copies/ml.We also perform genotype drug resistance test to analyze the occurrence and characteristics of drug resistance.Result We observe 308 patients,and obtain 288 gene sequences successfully.The gene subtype is mainly CRF01_AE,while the total drug resistant rate is 40.63%(117/288),and the mutation rate of drug resistant gene is 56.94%(165/288).The nucleoside reverse transcriptase inhibitors(NRTIs)resistance mutation sites were mainly M184V,D67N and K65R.The non-nucleoside reverse transcriptase inhibitors(NNRTIs)resistance mutation sites were mainly K103N,G190A,Y181C and V179D.Protease inhibitors(PIS)resistance mutation sites were mainly L10I,L10V and A71V.Conclusion In Liuzhou,Guangxi,HIV-1 genotype drug resistant is very high in patients who fail in HAART,so they need more drug resistant monitoring so as to figure out the system of drug resistant mutational sites,doctors will be familiar with the existence of drug-resistant and cross-drug-resistant patterns among antiretrovirals,it is beneficial for patients to be compatible with the appropriate first-line treatment plan and delay the use of second-line drugs.

关 键 词：人类免疫缺陷病毒/艾滋病 抗病毒治疗失败 基因型耐药 突变位点 

分 类 号：R512.91[医药卫生—内科学]