广州市病毒学抑制失败HIV/AIDS患者的耐药特征及影响因素分析  

Characteristics of genotype drug resistance and influencing factors of HIV/AIDS patients with virology failure in Guangzhou

作　　者：李佳佳 李凌华[1,2] 吕诗韵 冯凯 刘琳珊 钟海丹 颜婵 刘聪 Li Jiajia;Li Linghua;Lv Shiyun;Feng Kai;Liu Linshan;Zhong Haidan;Yan Chan;Liu Cong(Guangzhou Medical Research Institute of Infectious Diseases,Guangzhou Eighth People's Hospital,Guangzhou Medical University,Guangzhou,510440,China;Infectious Disease Center,Guangzhou Eighth People's Hospital,Guangzhou Medical University,Guangzhou 510440,China)

机构地区：[1]广州医科大学附属市八医院、广州市传染病临床医学研究所,广东广州510440 [2]广州医科大学附属市八医院感染病中心,广东广州510440

出　　处：《中华卫生应急电子杂志》2024年第4期207-212,共6页Chinese Journal of Hygiene Rescue(Electronic Edition)

基　　金：国家自然基金(82302513)广州市科技计划项目(20220020285,2023A03J0801);2023年-2025年华英科研基金项目(HY202301C02);2021~2023年广州市医学重点学科(2022YFC2304803)。

摘　　要：目的分析广州市发生病毒学抑制失败的艾滋病毒(HIV)感染者/艾滋病(AIDS)患者的基因型耐药特征,并探讨影响耐药的因素。方法回顾性分析2021 年3 月至2023 年3 月在广州市某感染门诊接受抗病毒治疗(ART)后发生病毒学抑制失败并有完整耐药分析报告的394例HIV/AIDS患者的临床资料,运用二元Logistics回归方法分析耐药发生的影响因素。结果152例发生了耐药,耐药发生率为38.6%。其中分别有106 例(26.9%)、115 例(29.2%)、10 例(2.5%)和3 例(0.8%)患者对核苷酸逆转录酶抑制剂(NRTIs)、非核苷酸类逆转录酶抑制剂(NNRTIs)、蛋白酶抑制剂(PIs)和整合酶抑制剂(INSTIs)耐药。100例(65.8%)患者出现对拉米夫定(3TC)、恩曲他滨(FTC)的中高度耐药。分别有108例(71.1%)和94例(61.8%)患者对奈韦拉平(NVP)和依非韦伦(EFV)中高度耐药。多因素Logistic分析显示,基线CD4^(+)T淋巴细胞计数≤200个/μL、近期CD4^(+)T淋巴细胞计数≤200个/μL、201~399个/μL、耐药检测时HIV 病毒载量≥1000copies/mL 是耐药发生的危险因素。结论广州市ART 后发生病毒学失败的HIV/AIDS 患者耐药情况复杂,耐药位点多样,低CD4^(+)T 淋巴细胞计数和高HIV 病毒载量是发生耐药的危险因素。Objective To analyze the genotype resistance characteristics of HIV/AIDS patients who had failed virology in Guangzhou, and to explore the factors affecting the occurrence of drug resistance.Methods The clinical data of HIV/AIDS patients who failed virology and had a complete drug resistance report after antiretroviral therapy (ART) were retrospectively analyzed in an infection clinic in Guangzhou from March 2021 to March 2023 and the binary logistics regression method was used to analyze the incidence of drug resistance.Results A total of 394 patients with virological failure were included, of which 152 developed resistance, resulting in a resistance rate of 38.6%. Among these, 106 cases (26.9%),115 cases (29.2%), 10 cases (2.5%), and 3 cases (0.8%) exhibited resistance to nucleoside reverse transcriptase inhibitors (NRTIs), non - nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase inhibitors (INSTIs), respectively. Additionally, 100 cases (65.8%) showed moderate to high resistance to lamivudine (3TC) and emtricitabine (FTC). Furthermore, 108 cases (71.1%)and 94 cases (61.8%) showed moderate to high resistance to nevirapine (NVP) and efavirenz (EFV),respectively. Multi-factor logistic analysis showed that the baseline CD4^(+) T lymphocyte count was ≤200/μL,recent CD4^(+) T lymphocyte count was ≤200/μL, 201~399/μL,and HIV load was ≥1000 copies/ml during drug resistance detection, which were resistant risk factors for the occurrence of drug resistance.ConclusionHIV/AIDS patients with virological failure after ART in Guangzhou are complex in drug resistance, and the drug resistance sites are diverse. Low CD4^(+)T lymphocyte count and high HIV load are risk factors for drug resistance.

关 键 词：人类免疫缺陷病毒 基因型耐药 病毒学失败 

分 类 号：R512.91[医药卫生—内科学]