2017—2021年北京市50岁以上艾滋病感染者抗病毒治疗前耐药情况及影响因素分析  

The drug resistance and its influencing factors among of HIV-infected patients aged over 50 years in Beijing from 2017 to 2021

作　　者：李建维[1] 刘安[1] 王茜[1] 高月[1] 王博 孙丽君[1] 代丽丽[1] 张广[2] 李在村[1] LI Jian-wei;LIU An;WANG Qian;GAO Yue;WANG Bo;SUN Li-jun;DAI Li-li;ZHANG Guang;LI Zai-cun(Beijing You′an Hospital,Capital Medical University,Beijing 100015,China;不详)

机构地区：[1]首都医科大学附属北京佑安医院,北京100069 [2]中国疾病预防控制中心性病艾滋病预防控制中心,北京102206

出　　处：《中国病毒病杂志》2022年第4期296-303,共8页Chinese Journal of Viral Diseases

摘　　要：目的了解北京市50岁以上人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者接受抗病毒治疗前HIV耐药情况,为预防耐药毒株传播和提高抗病毒治疗效果提供参考。方法开展2017—2021年首都医科大学北京佑安医院性病艾滋病门诊的连续横断面调查,收集50岁以上未接受抗病毒治疗的HIV感染者基本信息以及初始CD4~+T淋巴细胞、初始病毒载量,采集外周静脉血,提取其HIV-1 pol基因区序列进行测序和分析,采用单因素及多因素logistic回归模型分析,以了解耐药突变位点和对药物的耐药程度及影响因素。结果535例研究对象中,平均年龄(56.5±6.2)岁,以男性为主(89.7%,480/535),传播途径以同性性行为传播为主(73.3%,392/535);总耐药率为13.5%(72/535)。与非核苷反转录酶抑制剂(non-nucleoside reverse transcriptase inhibitors,NNRTIs)、核苷类反转录酶抑制剂(nucleoside reverse transcriptase inhibitors,NRTIs)、蛋白酶抑制剂(protease inhibitor,PIs)单独有关的耐药分别占84.7%(61/72)、2.8%(2/72)、4.2%(3/72),发生NRTIs和NNRTIs、NNRTIs和PIs交叉耐药分别占5.6%(4/72)和2.8%(2/72);V179D/V179E是NNRTIs主要的突变位点。多因素logistic回归分析结果显示,相对于已婚的研究对象,丧偶或离婚的耐药风险较高(OR=1.98,95%CI:1.00~3.94)。结论北京市50岁以上HIV感染者抗病毒治疗前耐药发生率较高,以NNRTI类药物单耐药为主,NNRTIs与NRTIs、PIs多重耐药并存,建议参考抗病毒治疗前耐药监测结果,指导个体化的治疗。Objective To describe the drug resistance of human immunodeficiency virus(HIV)infected patients aged over 50 years in Beijing before antiretroviral therapy(ART),and to discuss its influencing factors,in order to provide evidence for preventing the transmission of drug-resistant strains and improving the efficacy of ART.Methods A continuous cross-sectional survey was conducted in the STD/AIDS clinic of Beijing You′an Hospital from 2017 to 2021.The baseline information including demographic,CD4T cell count and viral load of HIV-infected patients aged over 50 years who did not receive ART was recorded.Peripheral blood samples were also collected,and HIV-1 pol gene region was amplified,sequenced and analyzed to identify the drug resistance mutation sites and drug resistance degree.Logistic regression model was used to analyze the influencing factors.Results A total of 535 subjects were recruited,with median age of(56.5±6.2)years.There were 89.7%(480/535)males,and 73.3%(392/535)were infected via homosexual sex.The overall HIV drug resistance rate was 13.5%(72/535).The drug resistance rate was 84.7%(61/72)to non-nucleoside reverse transcriptase inhibitors(NNRTIs),2.8%(2/72)to nucleoside reverse transcriptase inhibitors(NRTIs)and 4.2%(3/72)to protease inhibitors(PIs).The drug resistance rate was 5.6%(4/72)to both NRTIs and NNRTIs and 2.8%(2/72)to both NNRTIs and PIs.V179D/E was found to be the leading mutation sites of NNRTIs.Multivariate logistic regression analysis showed that compared to married cases,widowed or divorced subjects had a higher risk of drug resistance to ART(OR=1.98,95%CI:1.00—3.94).Conclusions The drug resistance rate before ART is relatively high among HIV infected patients aged over 50years in Beijing,with predominantly single resistance to NNRTIs,along with multi-resistance to NNRTIs,NRTIs and PIs.It is suggested to refer to the result of drug resistance surveillance data before ART to guide individualized treatment.

关 键 词：艾滋病病毒 抗病毒治疗 传播性耐药 监测 

分 类 号：R512.91[医药卫生—内科学]