刘佳,崔为国,刘春华,朱新朋,豆智慧,吴亚松,朱谦,王哲.河南省257例艾滋病一线抗病毒治疗失败患者耐药状况研究[J].中华流行病学杂志,2012,33(3):318-322 |
河南省257例艾滋病一线抗病毒治疗失败患者耐药状况研究 |
Study on HIV-1 drug resistance profile of 257 AIDS patients with failure on the first-line antiretroviral treatment in Henan |
收稿日期:2011-10-13 出版日期:2014-09-09 |
DOI: |
中文关键词: 艾滋病 抗病毒治疗 耐药状况 |
英文关键词: Acquired immunodeficiency syndrome Antiretroviral treatment Drug resistance |
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中文摘要: |
目的 了解河南省一线抗病毒治疗失败的艾滋病患者基因型耐药的状况,并对不同地区患者的耐药情况进行比较.方法 选取2010年河南省3个地区(A、B和C)一线抗病毒治疗失败的艾滋病患者276例,进行CD4+T淋巴细胞、病毒载量和基因型耐药检测,对耐药的发生率和耐药突变位点进行分析.结果 总耐药率为68.48%( 176/257,有19例未成功扩增),非核苷类反转录酶抑制剂(NNRTIs)的耐药率最高为67.70%,核苷类反转录酶抑制剂(NRTIs)的耐药率为54.09%,蛋白酶抑制剂(PIs)的耐药率为1.18%.A、B和C地区的耐药率分别为82.35%、97.47%和52.80%,3个地区患者的耐药率差异有统计学意义(x2=50.624,P=0.000);NNRTIs和NRTIs的耐药率差异也有统计学意义(x2=48.771,P=0.000;x2=33.912,P=0.000).M184V/I是发生最多的NRTIs类耐药突变位点,发生率为26.46%,A和B地区的M184V/I发生率(47.06%和49.37%)显著高于C地区(13.04%)(x2=39.905,P=0.000),其次是TAMs相关突变,TAMs-1和TAMs-2分别为8.56%和4.28%,C地区的TAMs-1显著少于A和B地区(x2=13.499,P=0.001).≥1 TAM的为40.47%,其中T215Y/F最多,发生率为33.85%.K103N是出现最多的NNRTIs类耐药突变,为31.13%,其在3个地区发生率的差异均有统计学意义(x2=14.213,P=0.001).耐PIs的突变位点有2个,M461/L为1.17%,V82F为0.39%,A地区未出现主要耐PIs的突变位点.结论 河南省不同地区的耐药状况有明显差异,应区别对待,而艾滋病二线抗病毒治疗工作应及时、严格和规范. |
英文摘要: |
Objective To understand the current situation related to genotypic resistance in patients receiving the first-line antiretroviral treatment,but with with virologic failure,in Henan province and to compare the patterns of drug resistance in patients from different areas.Methods 276 patients with virologic failure on first-line antiretroviral treatment were selected in three different areas of Henan,in 2010.CD4 +T cells,virus load and genotypic resistance were measured and tested.Prevalence and mutations related to drug-resistant were analyzed.Results The overall prevalence of drug-resistance was 68.48% in 257 patients,with non-nucleoside reverse transcriptase inhibitor (NNRTIs) as 67.70%.Rate of nucleoside reverse transcriptase inhibitor (NRTIs) was 54.09%,and protease inhibitors (PIs) was 1.18%.The prevalence rates of drug-resistance in A,B and C groups were 82.35%,97.47% and 52.80%,respectively,and withs significant differences (x2=50.624,P=0.000).The Prevalence rates related to resistance of NNRTIs and NRTIs were also significantly different ( x2=48.771,P=0.000 and x2=33.912,P=0.000).26.46% of the samples had M184V/I mutation which was the highest NRTIs mutation among the 257 patients.The prevalence rates on resistance of A and B were 47.06% and 49.37%,higher than that of C( 13.04%,x2=39.905,P=0.000)followed by TAMs,TAMs-1 and TAMs-2 which were 8.56% and 4.28%.C had the lower prevalence of TAMs-1 thanA and B (x2=13.499,P=0.001).40.47% of the samples harbored ≥1 TAM,with T215Y/F having the most,as 33.85%.31.13% of 257 patients appeared most NNRTIs mutation K103N in this study,with the prevalence rates also significant different (x2=14.213,P=0.001 ) in the three areas.Two PIs mutations were detected in 257 patients:M461/L,(1.17%) and V82F (0.39%).However,none was detected in area A.Conclusion Different patterns of drug resistance were found in different areas of Henan province and should be treated differently.The work related to AIDS second-line antiretroviral therapy in Henan should be more opportune,rigorous and standardized. |
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