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

刘佳; 崔为国; 刘春华; 朱新朋; 豆智慧; 吴亚松; 朱谦; 王哲

Abstract

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].Chinese journal of Epidemiology,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

Received:October 13, 2011

DOI：

KeyWord: 艾滋病抗病毒治疗耐药状况

English Key Word: Acquired immunodeficiency syndrome Antiretroviral treatment Drug resistance

FundProject:

Author Name	Affiliation
LIU Jia	Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
CUI Wei-guo	Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
LIU Chun-hua	Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
ZHU Xin-peng	Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
DOU Zhi-hui	Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
WU Ya-song	Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
ZHU Qian	Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
WANG Zhe	Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China

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Abstract:

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.

English Abstract:

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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