2011-2020年云南省50岁及以上抗病毒治疗失败的HIV/AIDS患者基因型耐药研究  

Genotyping resistance of HIV/AIDS patients aged over 50 years with antiviral treatment failure in Yunnan,2011-2020

作　　者：阮尉月清 刘家法 张米 李健健 邓雪媚 马莎 董兴齐 RUAN Wei-yue-qing;LIU Jia-fa;ZHANG Mi;LI Jian-jian;DENG Xue-mei;MA Sha;DONG Xing-qi(Department of Laboratory,Yunnan Provincial Infectious Diseases Hospital/AIDS Care Center,Kunming,Yunnan 650301,China;不详)

机构地区：[1]云南省传染病医院/云南省艾滋病关爱中心,云南昆明650301 [2]昆明医科大学 [3]昆明医科大学第二附属医院感染管理办公室

出　　处：《现代预防医学》2023年第18期3431-3437,共7页Modern Preventive Medicine

基　　金：云南省高层次卫生技术人才培养经费资助项目(H-2019047);云南省科技厅重大科技专项计划(202102AA310005)。

摘　　要：目的分析2011-2020年间云南省≥50岁抗病毒治疗(Antiretroviral therapy,ART)失败的艾滋病病毒感染者和艾滋病患者(HIV/AIDS)的耐药情况,为该人群耐药的预防和ART治疗提供参考依据.方法收集云南省2011年1月-2020年12月期间≥50岁ART失败患者的人口学信息及耐药检测结果进行综合分析.结果2011-2020年间≥50岁的HIV/AIDS患者ART失败1865例,其中总体耐药率为57.64%.不同年龄、地区、基因亚型、首次治疗方案、治疗时长的耐药率差异有统计学意义(P<0.05),其中50~60岁年龄段的病例耐药率相对较高,为59.26%;边境地区耐药率相对较高,尤其临沧市达到了73.08%;基因亚型CRF01_AE耐药率相对较高,为69.05%;首次治疗方案中一线治疗方案替诺福韦(TDF)+拉米夫定(3TC)+奈韦拉平(NVP)耐药耐药率最高,为72.50%,而二线治疗方案耐药率较低.并且研究显示该人群对3TC和恩曲他滨(FTC)以及NVP高度耐药情况较为严重.结论2011-2020年云南省≥50岁HIV/AIDS入组患者人数占比呈现逐年上升趋势,该人群的累计耐药率较全年龄段人群高,应结合该人群的特殊性加强对该人群的管理,加强耐药监测,防止多重耐药导致治疗失败的发生.Objective To analyze the drug resistance of HIV/AIDS patients aged≥50 years who failed antiviral treatment in Yunnan Province from 2011 to 2020,and to provide reference for the prevention of drug resistance and ART treatment in this population.Methods Demographic information and drug resistance test results of ART failure patients≥50 years old in Yunnan Province from January 2011 to December 2020 were collected for comprehensive analysis.Results There were 1865 cases of ART failure in HIV/AIDS patients aged≥50 years from 2011 to 2020,and the overall drug resistance rate was 57.64%.There were significant differences in drug resistance rate among different age,region,gene subtype,treatment plan and treatment duration(P<0.05),among which the drug resistance rate of 50-60 years old patients was relatively higher(59.26%).The rate of drug resistance in border areas was relatively high,especially in Lincang City,where it reached 73.08%.The drug resistance rate of gene subtype CRF01_AE was 69.05%.In the first treatment regimen,the first-line treatment regimen Tenofovir(TDF)+Lamivudine(3TC)+Nevirapine(NVP)had the highest drug resistance rate(72.50%),while the second-line treatment had a lower drug resistance rate.Moreover,studies showed that this population was highly resistant to 3TC,Emtricitabine(FTC)and NVP.Conclusion From 2011 to 2020,the proportion of HIV/AIDS enrolled patients aged≥50 in Yunnan Province show an increasing trend year by year.The cumulative drug resistance rate of this population is higher than that of the entire age group.Therefore,it is necessary to strengthen the management of this population based on its unique characteristics,strengthen drug resistance monitoring,and prevent the occurrence of treatment failure caused by multiple drug resistance.

关 键 词：人类免疫缺陷病毒1型 抗病毒治疗 基因型耐药 ≥50岁人群 

分 类 号：R512.91[医药卫生—内科学]