中国西南地区艾滋病病毒感染者治疗前和获得性抗逆转录病毒耐药性研究  

Pre-treatment and Acquired Antiretroviral Drug Resistance among People Living with HIV in Southwest China

作　　者：孔令弘 谢小馨 符燕华 甘霖 杨小燕 马淑静 龙海 KONG Linghong;XIE Xiaoxin;FU Yanhua;GAN Lin;YANG Xiaoyan;MA Shujing;LONG Hai(The Key Laboratory of Environmental Pollution Monitoring and Disease Control,Ministry ofEducation/School of Public Health,Guizhou Medical University,Guiyang 561113,China;Guiyang Public Health Clinical Center,Guiyang 550001,China)

机构地区：[1]贵州医科大学公共卫生与健康学院环境污染与疾病监控教育部重点实验室,贵州省贵阳市561113 [2]贵州省贵阳市公共卫生救治中心,550001

出　　处：《中国全科医学》2025年第2期242-249,共8页Chinese General Practice

基　　金：贵州省科技计划项目(黔科合支撑[2021]一般055)。

摘　　要：背景中国不同地区人类免疫缺陷病毒(HIV)感染者的治疗前耐药(PDR)和获得性耐药(ADR)的患病率及流行情况差异较大。这两种耐药对患者的抗病毒治疗效果具有不良影响,可能会加剧患者不良预后的发生。目前针对中国西南地区的HIV感染者PDR和ADR患病率及流行情况的研究较少。目的调查在中国西南地区HIV感染者PDR和ADR的患病率及流行情况。方法纳入2021-01-01—2023-06-30在贵阳市公共卫生救治中心就诊并进行耐药基因检测的HIV感染者。使用HIV-1 pol序列分析HIV-1基因型和耐药性。使用斯坦福大学HIV耐药性数据库分析逆转录酶和蛋白酶Sanger序列的主要耐药性突变。通过Logistic回归模型评估与PDR相关的风险因素。结果共1613例HIV感染者参与研究,其中824例初治,789例经治。初治患者最常见的基因型为B+C(47.0%),耐药率为18.7%(154/824),非核苷类逆转录酶抑制剂(NNRTIs)为14.9%(123/824),核苷类逆转录酶抑制剂(NRTIs)为1.7%(14/824),蛋白酶抑制剂(PIs)为2.7%(22/824),整合酶链转移抑制剂(INSTIs)为1.9%(16/824)。经治患者最常见的基因型为CRF01-AE(37.4%),耐药率为27.8%(219/789),NNRTIs、NRTIs、PIs和INSTIs的突变率分别为7.7%(61/789)、19.3%(152/789)、2.7%(21/789)和1.1%(9/789)。多因素Logistic回归分析结果显示,传播途径、CD_(4)^(+)T细胞计数、病毒载量和确诊与抗逆转录病毒疗法(ART)间隔时间是HIV感染者PDR的影响因素(P<0.05)。结论流行于中国西南地区的HIV感染者PDR和ADR发生率较高,分别为18.7%和27.8%。PDR的影响因素包括传播途径、CD_(4)^(+)T细胞计数、病毒载量和确诊与ART间隔时间。因此,为了避免耐药性发生,迫切需要常规基线基因型耐药性检测和足够的病毒载量监测间隔时间。Background The prevalence and epidemiology of pre-treatment drug resistance(PDR)and acquired drug resistance(ADR)among HIV-infected individuals vary considerably in different regions of China.Both types of drug resistance have adverse effects on the antiviral treatment outcomes for patients,potentially exacerbating their poor prognosis.Currently,there is a paucity of research on the prevalence and epidemiology of PDR and ADR among HIV-infected individuals in Southwest China.Objective This study investigated the prevalence and epidemiology of pre-treatment drug resistance and acquired drug resistance among people living with HIV(PLWH)in Southwest China.Methods This was a large cross-sectional study that enrolled PLWH who visited Guiyang Public Health Clinical Center between January 1,2021,and June 30,2023,and underwent drug resistance gene testing.HIV-1 genotype and drug resistance were analyzed using HIV-1 pol sequence.The Stanford University HIV Drug Resistance Database was used to analyze major drug resistance mutations in the reverse transcriptase and protease Sanger sequences.Risk factors associated with pre-treatment drug resistance were evaluated using a Logistic regression model.Results A total of 1613 individuals were included in the study,with 824 ART-naive and 789 ART-experienced.The most common genotype among ART-naive patients was B+C(47.0%),and the drug resistance rate was 18.7%(154/824)with non-nucleoside reverse transcriptase inhibitors(NNRTIs)accounting for 14.9%(123/824),nucleoside reverse transcriptase inhibitors(NRTIs)accounting for 1.7%(14/824),protease inhibitors(PIs)accounting for 2.7%(22/824),and integrase strand transfer inhibitors(INSTIs)accounting for 1.9%(16/824).Among the ART-experienced patients,the most common genotype was CRF01-AE(37.4%),with a drug resistance rate of 27.8%(219/789).The mutation rates for NNRTIs,NRTIs,PIs,and INSTIs were 7.7%(61/789),19.3%(152/789),2.7%(21/789),and 1.1%(9/789),+respectively.Furthermore,multivariate Logistic regression modeling revealed that transmis

关 键 词：HIV 耐药 基因型 治疗前耐药 获得性耐药 危险因素 

分 类 号：R373.9[医药卫生—病原生物学]