河南某农村艾滋病患者劣势耐药毒株的进化及原发耐药研究

Study on the evolution of the minor resistant mutations and the primary resistance in rural areas of Henan

目的了解河南省部分艾滋病患者抗病毒治疗效果及耐药发生情况，分析劣势耐药毒株在该人群本底存在情况。方法以河南某农村149名初始接受抗病毒治疗的艾滋病患者为研究对象，采用自建（In-house）基因型耐药检测方法分析抗病毒治疗失败患者HIV-1耐药发生情况，对抗病毒治疗后产生耐药的病例采用等位基因特异性实时定量PCR（allele-specificreal-timePCR，ASPCR）方法检测其抗病毒治疗前样本劣势耐药毒株存在情况。结果抗病毒治疗后患者的HIV-1病毒载量显著下降（t=275，P：0．0001），但CD4’T淋巴细胞绝对数无明显变化（t=1．765168，P=0．0852）。抗病毒治疗失败患者中耐药的发生率为4．88％，ASPCR检测发现，在调查基线时，7例耐药患者全部存在劣势M184V突变，5例存在劣势K103N突变。结论河南省部分未治疗的艾滋病患者存在HIV-1原发性耐药毒株，劣势耐药突变可能发展为优势耐药毒株并影响抗病毒治疗的效果。

Objective To evaluate the antiretroviral therapy（ ART）, analyze the prevalence of resistance in rural areas, Henan, and explore the presence of minor resistant variants in pre-ART. Methods One hundred and forty-nine AIDS patients initiating ART were recruited and investigated at intervals of 6 months. Method of In-house developed by our laboratory for genotypic resistance test was to analyze the occurrence of resistance among the failure of ART, and the allele-specific real-time PCR（ASPCR） was used to detect the minor resistant variants at the baseline samples once the resistance occurred. Results Viral load significantly decreased among the patients who received ART（ t = 275, P = 0.0001 ）, but the absolute counts of CIM ~ T lymphocytes had no significant change （ t= 1. 765 168, P = 0.0852 ）. Rate of resistance among the patients of treatment failure was 4.88%. The result of ASPCR in the survey of baseline showed that the minor resistant variants of M184V were detected in 7 patients and mutation K103N presented in 5 patients. Conclusion The primary drug-resistant strains in the untreated patients were found in Henan, and they might develop the dominant resistance strains and bring about the failure of ART.