中国部分地区人免疫缺陷病毒耐药及其影响因素分析

HIV drug resistance and influence factors in some provinces of China

目的分析吉林、黑龙江、河南、陕西、辽宁、内蒙古、云南7省人类免疫缺陷病毒(HIV)感染者耐药变异情况及其影响因素。方法2005年5月至9月将中国医科大学附属第一医院艾滋病研究所问卷调查的718例HIV感染者治疗和漏服情况,RT-PCR和套式PCR扩增HIVpol区基因,逆转录酶和蛋白酶基因序列,与国际HIV耐药数据库比对辨别耐药变异。结果治疗组HIV抑制情况显著好于未治疗感染者(P<0.01),但其耐药变异高于未治疗组(P<0.05);抗病毒治疗6个月以内组耐药突变率显著低于6个月以上组(P<0.01);依从性好的患者HIV耐药突变率明显低于依从性差的患者(P<0.05),HIV抑制情况明显优于依从性差的患者(P<0.05);D4T/3TC/NVP方案HIV抑制效果明显优于其他方案(P<0.01),HIV耐药突变率也较低(P<0.05)。结论随着抗病毒治疗时间延长,耐药突变率显著增高,服药依从性与耐药突变显著相关。一线治疗方案首选D4T/3TC/NVP。

Objective To prevent the prevalence of drug resistance viruses, we analyzed drug resistance mutations of HIV-1 among HIV-1 infected individuals in seven provinces of China. Methods We acquired 718 HIV-1 infected patients＇ treatment and compliance from questionnaires, amplified HIV-1 pol genes by RT-PCR and nest-PCR, sequenced RT and protease regions and run clustal with the subtype B consensus amino acid sequence in Stanford HIV drug resist- ance sequence database. Results The viral load in treated patients was obviously lower than that in untreated patients（P 〈 0. 01 ） and drug resistance mutations in treated patients was higher than in untreated patients （ P 〈 0. 05 ） ; drug resistance mutations in patients who received HAART less than six months had distinctly lower frequency than those patients who received HAART more than six months （ P 〈 0. 05 ） ; drug resistance mutations in patients who followed doctors had distinctly lower frequency than those patients who didn＇t do it （P 〈 0. 05 ）, and the viral load in patients who followed doctom was obviously lower than others （ P 〈 0. 05 ） ; the viral load in patients who received IMT/3TC/NVP was obviously lower than others （ P 〈 0. 01 ） and drug resistance mutations in these patients also had lower frequency （ P 〈 0. 05 ）. Con- clusion Owing to the extensive use of HAART,the frequency of drug resistance mutations obviously increase and there is significant correlation between compliance and drug resistance mutations. To prevent the prevalence of drug resistance vi- ruses,we should strengthen to monitor the drug resistance mutations and supervise dose and recommend IMT/3TC/NVP as fimt choice.