| 陈宏利,周业胜,郝静静,张佳欣,胡婧,宋畅,李苗苗,李丹,冯毅,廖玲洁,阮玉华,邢辉,邵一鸣.抗病毒治疗前耐药对HIV感染者治疗3年后病毒学应答的影响[J].Chinese journal of Epidemiology,2022,43(11):1778-1783 |
| 抗病毒治疗前耐药对HIV感染者治疗3年后病毒学应答的影响 |
| Effects of pretreatment HIV drug resistance on the virological response of HIV-infected patients after 3-year antiretroviral therapy |
| Received:January 12, 2022 |
| DOI：10.3760/cma.j.cn112338-20220112-00028 |
| KeyWord: 艾滋病病毒 耐药 抗病毒治疗 病毒学抑制 |
| English Key Word: HIV Drug resistance Antiretroviral therapy Virological failure |
| FundProject:国家科技重大专项（2017ZX10201101，2018ZX10721102）；国家自然科学基金（11971479）；广西艾滋病防控与成果转化研究重点实验室和广西八桂学者艾滋病防控关键技术岗位专项（ZZH2020010） |
| Author Name | Affiliation | E-mail | | Chen Hongli | State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | | Zhou Yesheng | State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | | Hao Jingjing | State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | | Zhang Jiaxin | State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | | Hu Jing | State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | | Song Chang | State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | | Li Miaomiao | State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | | Li Dan | State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | | Feng Yi | State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | | Liao Lingjie | State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | | Ruan Yuhua | State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | ruanyuhua92@chinaaids.cn | | Xing Hui | State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | | Shao Yiming | State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | |
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| Abstract: |
| 目的 了解抗病毒治疗前耐药对HIV感染者治疗3年后的病毒学应答的影响。方法 2018年对HIV感染者开展抗病毒治疗前耐药基线调查，进行抗病毒治疗3年后随访。通过临床数据和病毒学实验室检测指标进行统计分析。结果 2 433例研究对象中，18~34岁占41.6%（1 012/2 433），男性占82.8%（2 015/2 433），高中及以上占46.9%（1 142/2 433），务农占22.4%（544/2 433），未婚占33.8%（823/2 433），异性性传播占48.1%（1 169/2 433），CRF07_BC亚型占41.3%（1 004/2 433）。抗病毒治疗前耐药率为4.5%（109/2 433）。抗病毒治疗3年后病毒学抑制失败率（病毒载量≥50拷贝数/ml）和耐药率分别为8.1%（196/2 433）和2.5%（60/2 433），其中抗病毒治疗前耐药和不耐药的病毒学抑制失败率分别为18.3%（20/109）和7.6%（176/2 324）、耐药率分别为4.6%（5/109）和2.4%（55/2 324）。多因素logistic回归模型分析结果显示，抗病毒治疗前耐药对HIV感染者治疗3年后的病毒学抑制失败的影响因素包括文盲（aOR=3.26，95%CI：1.82~5.86）、小学/初中（aOR=1.54，95%CI：1.09~2.18）、抗病毒治疗3年后CD4+T淋巴细胞计数<200个/μl和200~499个/μl（aOR=2.77，95%CI：1.75~4.37；aOR=1.55，95%CI：1.10~2.18）、最近1个月漏服抗病毒治疗药物（aOR=4.24，95%CI：2.92~6.17）和抗病毒治疗前耐药（aOR=2.84，95%CI：1.67~4.85）。结论 我国HIV感染者抗病毒治疗前耐药处于低流行水平，抗病毒治疗3年后病毒学抑制失败率较高。建议加强HIV感染者的耐药监测，重视抗病毒治疗前耐药对抗病毒治疗效果的影响。 |
| English Abstract: |
| Objective To investigate the impact of pretreatment drug resistance (PDR) on virological effect among HIV-infected patients having received antiretroviral therapy (ART) after three years. Methods The baseline survey of PDR among HIV-infected patients was conducted in 2018, with a three-year follow up study. The clinic data and virological laboratory test variables were statistically analyzed. Results Of the 2 433 participants, 41.6% (1 012/2 433) were aged between 18 and 34, 82.8% (2 015/2 433) were males, 46.9% (1 142/2 433) had education of high school or above, 22.4% (544/2 433) were farmers, 33.8% (823/2 433) were unmarried, 48.1% (1 169/2 433) were infected heterosexually and 41.3% (1 004/2 433) were with CRF07_BC. The prevalence of PDR was 4.5% (109/2 433). The prevalence of virological suppression failure (viral load ≥ 50 copies/ml) and drug resistance at three years follow up after ART was 8.1%(196/2 433) and 2.5%(60/2 433) respectively. The prevalence of virological suppression failure and drug resistance at three years follow up after ART were 18.3% (20/109) and 7.6% (176/2 324), and 4.6% (5/109) and 2.4% (55/2 324) among participants with PDR and non-PDR, respectively. The results of multivariate logistic regression model showed that illiteracy (aOR=3.26, 95%CI:1.82-5.86), primary and junior high school education (aOR=1.54, 95%CI:1.09-2.18), CD4+T lymphocyte count <200/μl (aOR=2.77, 95%CI:1.75-4.37) and CD4+T lymphocyte count 200-499/μl (aOR=1.55, 95%CI:1.10-2.18) at a three year follow up visit after ART, missed drugs in the past month (aOR=4.24, 95%CI:2.92-6.17), and PDR (aOR=2.84, 95%CI:1.67-4.85) were statistically significant with virological suppression failure on treatment. Conclusions The prevalence of PDR in China at a low level currently, and the virological suppression failure rate is low after three years of ART. It is necessary to strengthen drug resistance monitoring of HIV-infected patients and pay attention to the influence of PDR on treatment effect. |
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