2017-2019年我国西部三省部分地区HIV感染孕产妇抗病毒治疗药物耐药性发生及其相关因素分析  

Incidence and related factors of antiviral drug resistance in HIV-infected pregnant and postpartum women in some areas of three western provinces of China from 2017 to 2019

作　　者：孙贺 王爱玲[1] 姚均[2] 郑佳瑞[3] 覃清华[4] 沙吾力 王潇滟[1] 高雅 李珍 黄东旭 王前[1] Sun He;Wang Ailing;Yao Jun;Zheng Jiarui;Qin Qinghua;Sha Wuli;Wang Xiaoyan;Gao Ya;Li Zhen;Huang Dongxu;Wang Qian(National Center for Women and Children′s Health,Chinese Centers for Disease Control and Prevention,Beijing 100081,China;National Center for AIDS/STD Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China;Yunnan Provincial Maternal and Child Health Care Hospital,Kunming 650051,China;Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital,Nanning 530000,China;Xinjiang Maternal and Child Health Care Hospital,Urumqi 830000,China)

机构地区：[1]中国疾病预防控制中心妇幼保健中心,北京100081 [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 [3]云南省妇幼保健院,昆明650051 [4]广西壮族自治区妇幼保健院,南宁530000 [5]新疆维吾尔自治区妇幼保健院,乌鲁木齐830000

出　　处：《中华预防医学杂志》2023年第11期1788-1793,共6页Chinese Journal of Preventive Medicine

基　　金：中央财政专项“中国妇幼健康促进项目” (131031113000200002)。

摘　　要：目的分析2017—2019年我国西部三省部分地区HIV感染孕产妇耐药发生率和相关因素。方法于2017年4月至2019年4月在新疆、云南、广西三个省/自治区的7个预防艾滋病母婴传播项目地区所有提供孕产期保健及助产服务的医疗保健机构开展面对面问卷调查和血样本检测,完成孕期、分娩前和产后相关情况的信息收集和不同时期病毒载量、CD4+T淋巴细胞、耐药基因的检测。采用多因素logistic回归模型分析不同因素与HIV感染孕产妇发生耐药的关系。结果本研究共纳入655例HIV感染孕产妇,耐药发生率为3.4%(22/655),均为交叉耐药,低度耐药率为2.1%(14/655),中度耐药率1.2%(8/655),高度耐药率为0.8%(5/655),既往应用过抗病毒药物的人群中耐药率为1.9%(8/418),未应用过药物的人群为5.9%(14/237),NNRTI类耐药占2.8%(18/655),NRTI类耐药2.5%(16/655)。多因素logistic回归模型显示,既往应用过抗病毒药物的孕产妇发生HIV耐药的风险更低(OR=0.32,95%CI:0.11~0.76)。结论加强抗病毒药物使用的管理,重点关注既往未应用抗病毒药物的孕产妇,有助于降低耐药突变的发生,临床上应考虑个性化的抗病毒治疗方案实现病毒抑制的效果。Objective To analyze the incidence and related factors of drug resistance in HIV-infected pregnant and postpartum women in some areas of three western provinces of China from 2017 to 2019.Methods From April 2017 to April 2019,face-to-face questionnaires and blood sample testing were conducted in all health care institutions providing maternal and perinatal care and midwifery-assisted services in 7 prevention of mother-to-child transmissi project areas in Xinjiang,Yunnan and Guangxi provinces/autonomous regions.Information was collected during the perinatal period and viral load,CD4+T lymphocytes and drug resistance genes were detected at the same time.The multivariate logistic regression model was used to analyze the relationship between different factors and drug resistance in HIV-infected pregnant and postpartum women.Results A total of 655 HIV-infected pregnant and postpartum women were included in this study.The incidence of drug resistance was 3.4%(22/655),all of whom were cross-drug resistant.The rate of low,moderate and high drug resistance was 2.1%(14/655),1.2%(8/655)and 0.8%(5/655),respectively.The drug resistance rate in the people who had previously used antiviral drugs was 1.9%(8/418),and the drug resistance rate in the people who had not used drugs was 5.9%(14/237).The NNRTI drug resistance accounted for 2.8%(18/655)and the NRTI drug resistance rate was 2.5%(16/655).The multivariate logistic regression model showed that the risk of HIV resistance was lower in pregnant women who had previously used antiviral drugs(OR=0.32,95%CI:0.11-0.76).Conclusion Strengthening the management of antiviral drug use and focusing on pregnant and postpartum women who have not previously used antiviral drugs can help reduce the occurrence of drug-resistant mutations.Personalized antiviral therapy should be considered to achieve viral inhibition effects in clinical practice.

关 键 词：人类免疫缺陷病毒 孕妇 耐药 

分 类 号：R714.251[医药卫生—妇产科学]