2017—2021年成都市HIV-1抗病毒治疗失败者耐药情况分析  

Analysis of drug resistance in human immunodeficiency virus-1 antiviraltherapy failures in Chengdu City from 2017 to 2021

作　　者：高钰双 张燕琳[1] 郭悦 李姗珊 龚芳红[1] 朱丹 GAO Yushuang;ZHANG Yanlin;GUO Yue;LI Shanshan;GONG Fanghong;ZHU Dan(Chengdu Center for Disease Control and Prevention,Chengdu 610041,Sichuan Province,China.)

机构地区：[1]成都市疾病预防控制中心,成都610041

出　　处：《预防医学情报杂志》2023年第6期600-605,共6页Journal of Preventive Medicine Information

摘　　要：目的 分析成都市人类免疫缺陷病毒1型(human immunodeficiency virus-1,HIV-1)抗病毒治疗(Antiretroviral Therapy,ART)失败者耐药情况。方法 收集2017—2021年HIV-1 ART失败者治疗半年以上的血浆样本,进行耐药检测和亚型分析。率的比较采用卡方检验,以P<0.05为差异有统计学意义。结果 2017—2021年成都市ART失败的4 315例HIV-1感染者基因型耐药检测,成功获得序列3 421例,扩增成功率为79.3%。1 645例出现耐药,耐药率为48.1%(1 645/3 421)。不同年份耐药率分别为49.2%、43.4%、46.7%、51.3%和47.4%。核苷类反转录酶抑制剂(nucleoside reverse transcriptase inhibitor,NRTI)、非核苷类反转录酶抑制剂(non-nucleoside reverse transcriptase inhibitor,NNRTI)和蛋白酶抑制剂(protease inhibitor,PI)的耐药率分别为24.6%、45.1%和3.0%。基因亚型以重组型(circulating recombinant form,CRF)07_BC为主,占比49.5%(1 694/3 421);CRF07_BC、CRF01_AE、CRF08_BC、B、CRF55_01B和其他亚型的耐药率分别为42.3%、52.4%、50.8%、69.1%、72.4%和54.7%,差异有统计学意义(χ^(2)=60.6,P<0.001)。NNRTI最常见耐药突变位点为K103(57.6%),奈韦拉平(NVP)和依非韦伦(EFV)的耐药率最高,分别为44.3%和43.9%;NRTI最常见的耐药突变位点为M184(41.9%),阿巴卡韦(ABC)、拉米夫定(3TC)和恩曲他滨(FTC)的耐药率最高,分别为23.2%,23.1%和23.1%;PI主要耐药突变位点最常见为M46(2.9%),次要耐药突变位点最常见为Q58(2.1%),奈非那韦(NFV)耐药率最高,为2.1%。结论 成都市近五年HIV-1抗病毒治疗失败者耐药率较高,耐药突变位点多且复杂,需定期监测,以期达到有效治疗。Objective To analyze the drug resistance situation of human immunodeficiency virus-1(HIV-1)infected people who received antiretroviral therapy(ART)but failed in Chengdu City.Methods Plasma samples from HIV-1 infected cases who received ART at least for more than 6 months but failed finally from 2017 to 2021 were collected and performed by drug resistance test and subtype analysis.Chi-square test was used to compare the rates and P<0.05 was considered statistically significant.Results There were 4315 HIV-1 infected cases with ART failure in Chengdu from 2017 to 2021 detected for genotype resistance. The sequence of 3 421 cases was obtainedsuccessfully,and the success rate of amplification was 79.3%. Drug resistance was found in 1 645cases,and the drug resistance rate was 48.1%(1 645/3 421) . The drug resistance rates of differentyears were 49.2%, 43.4%, 46.7%, 51.3% and 47.4%, respectively. The drug resistance rates ofnucleoside reverse transcriptase inhibitors (NRTIs), non- nucleoside reverse transcriptase inhibitors(NNRTIs) and protease inhibitors (PIs) were 24.6%,45.1% and 3.0%,respectively. The main genesubtype was circulating recombinant form (CRF) 07_BC (49.5%,1 694/3 421) . The drug resistancerates of CRF 07_BC, CRF 01_AE, CRF 08_BC, B, CRF 55_01B and other subtypes were42.3%,52.4%,50.8%,69.1%,72.4% and 54.7%,respectively,and the difference was statisticallysignificant (χ^(2)=60.6,P<0.001) . The most common drug resistant mutation site in NNRTIs wasK103 (57.6%),and nevirapine (NVP) and efavirenz (EFV) had the highest drug resistance rates,which were 44.3% and 43.9% , respectively. The most common drug resistant mutation site inNRTIs was M184 (41.9%),and the drug resistance rates of abacavir (ABC),lamivudine (3TC)and emtricitabine (FTC) were the highest,which were 23.2%,23.1% and 23.1%,respectively. Themain and secondary drug resistant mutation sites which were most common in PIs were M46(2.9%) and Q58 (2.1%), and nelfinavir (NFV) had the highest drug resistance rate (2.1%) .Conclusions In recent five years

关 键 词：HIV-1 抗病毒治疗 耐药 突变 

分 类 号：R512.91[医药卫生—内科学]