2017—2021年宜宾市HIV感染者/AIDS病人抗病毒治疗后耐药情况分析  

Analysis on drug resistance of HIV infected/AIDS patients after antiviral therapy in Yibin City from 2017 to 2021

作　　者：何坤霖 李万书[1] 黄晓玲[1] 毛启培 梁俐 罗朝体 罗丽娟 韦茂 陈睿婕 刘耀 牟友林 李源 HE Kunlin;LI Wanshu;HUANG Xiaoling;MAO Qipei;LIANG Li;LUO Chaoti;LUO Lijuan;WEI Mao;CHEN Ruijie;LIU Yao;MOU Youlin;LI Yuan(Yibin Center for Disease Control and Prevention,Yibin 644000,Sichuan Province,China)

机构地区：[1]宜宾市疾病预防控制中心,四川宜宾644000

出　　处：《预防医学情报杂志》2023年第12期1434-1440,共7页Journal of Preventive Medicine Information

摘　　要：目的分析2017—2021年宜宾市HIV/AIDS抗病毒治疗耐药情况,为宜宾市科学高效开展艾滋病防治工作提供依据。方法收集2017—2021年宜宾市抗病毒治疗半年以上的HIV感染者/AIDS病人血浆进行病毒载量检测,对病毒载量≥1000 cps/ml的样本进行耐药监测,用卡方检验和Logistic回归分析治疗效果、耐药情况和影响因素,以P<0.05为差异有统计学意义。结果2017—2021年共收集到38182例接受抗病毒治疗半年以上的血浆样本,总病毒抑制率为87.76%,有4674例病毒载量≥1000 cps/ml,成功获得gag基因序列4156例,1844例感染者发生耐药,耐药发生率为4.83%。基因亚型以CRF85_BC、CRF01_AE、CRF08_BC和CRF07_BC为主,CRF85-BC为宜宾市HIV主要基因亚型;各基因亚型在性别、年龄、婚姻、文化、传播途径、抗病毒治疗时间、CD4基线以及是否耐药上差异均有统计学意义(P均<0.05),耐药发生与抗病毒治疗时间、基因亚型、初始治疗时基线CD4细胞数有关;患者耐药以NNRTIs(1780例,42.83%)和NRTIs(965例,23.23%)为主;耐药突变位点以M184和K103为主。结论宜宾市耐药率仍处于中度流行水平,今后需进一步加强耐药监测,及时为临床治疗和后续随访提供科学依据,不断提升全市艾滋病抗病毒治疗质量,减少耐药株的传播。Objective To analyze the antiviral treatment resistance of HIV/AIDS(human immunodeficiency virus/acquired immunodeficiency syndrome)in Yibin City from 2017 to 2021,and to provide basis for scientific and efficient AIDS prevention and treatment in Yibin City.Methods Plasma of HIV infected/AIDS patients receiving antiviral treatment for more than half a year in Yibin City from 2017 to 2021 was collected for viral load(VL)detection.Samples with VL≥1000 cps/ml were monitored for drug resistance.Chi-square test and Logistic regression were used to understand the treatment effect,drug resistance and influencing factors.P<0.05 was considered statistically significant.Results A total of 38182 plasma samples of HIV infected/AIDS patients receiving antiviral therapy for more than half a year were collected from 2017 to 2021.The total virus inhibition rate was 87.76%.There were 4674 cases with viral load≥1000 cps/ml.Gag gene sequences were obtained successfully in 4156 cases.Drug resistance occurred in 1844 cases,and the incidence of drug resistance was 4.83%.The gene subtypes were mainly CRF85_BC,CRF01_AE,CRF08_BC and CRF07_BC.CRF85-BC was the main gene subtype of HIV in Yibin City.There were significant differences among genotypes in gender,age,marriage,culture,route of transmission,duration of antiviral treatment,CD4 baseline and drug resistance(all P<0.05).The occurrence of resistance was related to the duration of antiviral therapy,the gene subtype,and the number of baseline CD4 cells at the time of initial treatment.Nonnucleoside reverse-transcriptase inhibitors(NNRTIs,1780 cases,42.83%)and nucleoside reverse transcriptase inhibitors(NRTIs,965 cases,23.23%)were the main drugs that patients resistant to.M184 and K103 were the main mutation sites for drug resistance.Conclusions The drug resistance rate in Yibin City is still at the moderate epidemic level.In the future,drug resistance monitoring should be further strengthened to provide scientific basis for clinical treatment and follow-up in time,constantly improve

关 键 词：HIV 耐药 抗病毒治疗 

分 类 号：R512.91[医药卫生—内科学]