| 李佳璐,郝静静,胡婧,宋畅,王栋,张智聪,阮玉华,冯毅,廖玲洁,邢辉.中国9个省份HIV-1感染者启动抗病毒治疗前利匹韦林耐药特征分析[J].中华流行病学杂志,2026,47(2):260-266 |
| 中国9个省份HIV-1感染者启动抗病毒治疗前利匹韦林耐药特征分析 |
| Drug resistance characteristics of rilpivirine in HIV-1-infected patients before starting antiretroviral therapy in nine provinces of China |
| 收稿日期:2025-08-02 出版日期:2026-02-13 |
| DOI：10.3760/cma.j.cn112338-20250802-00550 |
| 中文关键词: 艾滋病病毒 抗病毒治疗 耐药 利匹韦林 |
| 英文关键词: HIV Antiretroviral therapy Drug resistance Rilpivirine |
| 基金项目:国家重点研发计划（2022YFC2305201） |
| 作者 | 单位 | E-mail | | 李佳璐 | 传染病溯源预警与智能决策全国重点实验室, 中国疾病预防控制中心性病艾滋病预防控制中心, 北京 102206 | | | 郝静静 | 传染病溯源预警与智能决策全国重点实验室, 中国疾病预防控制中心性病艾滋病预防控制中心, 北京 102206 | | | 胡婧 | 传染病溯源预警与智能决策全国重点实验室, 中国疾病预防控制中心性病艾滋病预防控制中心, 北京 102206 | | | 宋畅 | 传染病溯源预警与智能决策全国重点实验室, 中国疾病预防控制中心性病艾滋病预防控制中心, 北京 102206 | | | 王栋 | 传染病溯源预警与智能决策全国重点实验室, 中国疾病预防控制中心性病艾滋病预防控制中心, 北京 102206 | | | 张智聪 | 传染病溯源预警与智能决策全国重点实验室, 中国疾病预防控制中心性病艾滋病预防控制中心, 北京 102206 | | | 阮玉华 | 传染病溯源预警与智能决策全国重点实验室, 中国疾病预防控制中心性病艾滋病预防控制中心, 北京 102206 | | | 冯毅 | 传染病溯源预警与智能决策全国重点实验室, 中国疾病预防控制中心性病艾滋病预防控制中心, 北京 102206 | | | 廖玲洁 | 传染病溯源预警与智能决策全国重点实验室, 中国疾病预防控制中心性病艾滋病预防控制中心, 北京 102206 | | | 邢辉 | 传染病溯源预警与智能决策全国重点实验室, 中国疾病预防控制中心性病艾滋病预防控制中心, 北京 102206 | xingh@chinaaids.cn |
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| 摘要点击次数: 2433 |
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| 中文摘要: |
| 目的 分析我国9个省份启动抗病毒治疗（ART）前的HIV-1感染者的利匹韦林（RPV）耐药特征。方法 采用横断面研究设计和按人口比例概率（PPS）抽样方法，选取9个省份（河北、吉林、江苏、浙江、湖北、重庆、四川、云南及新疆）作为研究现场，采用PPS抽样方法选取148个ART门诊点，研究对象为2022年1-6月ART前年龄≥18岁HIV-1感染者，对研究对象开展现场调查和基因型耐药指标的检测，应用SAS 9.4软件进行统计学分析，应用非条件logistic回归模型分析ART前HIV-1感染者RPV耐药的相关因素。结果 完成调查和采样3 165例HIV-1感染者，纳入研究对象2 821例，非核苷类反转录酶抑制剂（NNRTI）耐药率为10.1%（284/2 821），RPV耐药率为5.7%（160/2 821）。有ART药物暴露史的HIV-1感染者RPV耐药率为17.0%（16/94），RPV高度、中度和低度耐药等级构成比分别为7/16、2/16和7/16；无ART药物暴露史的HIV-1感染者RPV耐药率为5.3%（144/2 727），RPV高度、中度和低度耐药等级构成比分别为9.03%（13/144）、8.33%（12/144）和82.64%（119/144），两组HIV-1感染者RPV耐药率及RPV耐药等级的分布差异有统计学意义（χ2=16.94，P=0.001）。总体上，HIV-1感染者ART前RPV与依非韦伦/奈韦拉平（EFV/NVP）的交叉耐药率为57.5%（92/160），高于RPV与多拉韦林（DOR）（25.0%，40/160）和RPV与依曲韦林（ETR）（34.4%，55/160）的交叉耐药率（均P<0.001）。多因素logistic回归模型分析结果显示，HIV-1感染者ART前RPV耐药的正相关因素包括少数民族（aOR=1.86，95%CI：1.29~2.68）、有ART药物暴露史（aOR=2.57，95%CI：1.41~4.67）、CRF08_BC亚型（aOR=4.02，95%CI：2.46~6.55）、CRF55_01B亚型（aOR=3.81，95%CI：1.93~7.52）和B亚型（aOR=3.21，95%CI：1.40~7.37）。结论 我国9个省份HIV-1感染者在ART前对NNRTI和RPV耐药率均处于中等水平，RPV与EFV/NVP存在较高的交叉耐药性。有ART药物暴露史的HIV-1感染者RPV耐药率较高，建议针对HIV-1感染者ART前进行HIV-1耐药检测，并制定个体化治疗方案。 |
| 英文摘要: |
| Objective To understand the drug resistance characteristics of rilpivirine (RPV) in HIV-1-infected patients before starting antiretroviral therapy (ART) in nine provinces of China. Methods A cross-sectional study design was adopted by probability proportional to size(PPS) sampling. Nine provinces (Hebei, Jilin, Jiangsu, Zhejiang, Hubei, Chongqing, Sichuan, Yunnan and Xinjiang) were selected as the research sites. A total of 148 sites of ART outpatient clinics were selected by PPS sampling. The research subjects were HIV-1-infected patients aged ≥18 years before starting ART from January to June 2022. Field investigations and detection of genotype resistance indicators were conducted on the research subjects. Statistical analysis was performed using SAS 9.4 software, and unconditional logistic regression was applied to analyze the related factors of RPV resistance in HIV-1-infected patients before ART. Results A total of 3 165 HIV-1-infected patients were investigated and sampled, and 2 821 subjects were included in the study. The resistance rate of non-nucleoside reverse transcriptase inhibitors (NNRTI) was 10.1% (284/2 821), and the resistance rate of RPV was 5.7% (160/2 821). Among HIV-1-infected patients with a history of antiretroviral drug exposure, the RPV resistance rate was 17.0% (16/94), and the proportions of high-resistance, moderate-resistance, and low-resistance grades of RPV were 7/16, 2/16, and 7/16, respectively. Among HIV-1-infected patients without prior antiretroviral drug exposure, the RPV resistance rate was 5.3% (144/2 727), and the proportions of high-resistance, moderate-resistance, and low- resistance grades of RPV were 9.03% (13/144), 8.33% (12/144), and 82.64% (119/144), respectively. There were statistically significant differences in the RPV resistance rate and the distribution of RPV resistance grades between the two groups (χ2=16.94, P=0.001). The cross-resistance rate between RPV and efaviren/nevirapine (EFV/NVP) in total HIV-1-infected patients before ART was 57.5% (92/160), which was significantly higher than that between RPV and doravirine (DOR) (25.0%, 40/160) and that between RPV and etravirine (ETR) (34.4%, 55/160) (all P<0.001). The results of the multivariate logistic regression model analysis showed that the positive related factors of RPV resistance before ART in HIV-1-infected patients included other ethnic groups (aOR=1.86, 95%CI: 1.29-2.68) and with a history of antiretroviral drug exposure (aOR=2.57, 95%CI: 1.41-4.67), CRF08_BC (aOR=4.02, 95%CI: 2.46-6.55), CRF55_01B (aOR=3.81, 95%CI: 1.93-7.52) and B (aOR=3.21,95%CI:1.40-7.37). Conclusions The resistance rates of HIV-1-infected patients to NNRTI and RPV before ART were at a medium level in nine provinces of China, and there was a high cross-resistance between RPV and EFV/NVP. The RPV resistance rate of HIV-1-infected patients with a history of antiretroviral drug exposure was relatively higher. It is recommended to conduct HIV-1 resistance testing for them before starting ART and formulate individualized treatment plans. |
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