云南省140例HIV/AIDS患者抗病毒治疗效果和耐药检测分析

The antiviral therapy efficiency and drug resistance analysis among 140 HIV/AIDS patients in Yunnan

[目的]观察接受中国现行一线艾滋病抗病毒药物治疗的HIV/AIDS患者,在治疗1年内免疫学应答、病毒载量抑制效果,以及耐药性产生的情况。[方法]入组既往未接受过抗病毒治疗的HIV/AIDS患者140例,观察治疗0月、6月、12月CD4+T淋巴细胞计数(CD4)、病毒载量(VL),对治疗后VL>1000拷贝/ml的患者进行耐药检测。[结果]入组患者治疗前的CD4平均值为164个/μl,在治疗6个月和12个月分别上升至327个/μl和377个/μl。基线VL<1000拷贝/ml的患者比例为2.1%,治疗6个月和12个月后,分别上升至94.7%和94.4%。基线样本的耐药性检测未发现主要耐药突变位点。治疗6个月时有7例患者VL>1000拷贝/ml,耐药检测未发现耐药突变位点。治疗12个月时有7例VL>1000拷贝/ml,其中3例同时出现了对核苷类药物和非核苷类药物不同程度的耐药。[结论]云南省使用现行一线抗病毒治疗方案取得了良好的治疗效果。抗病毒治疗1年时,2.4%的患者出现了抗HIV药物耐药。出现耐药时需要及时更换抗病毒治疗方案,避免耐药位点的累积导致交叉耐药,保障抗病毒治疗疗效。

Objective To observe HIV/AIDS patients who accepted the first-line AIDS antiviral therapy, their immunology response, virus capacity suppression and the occurrence of drug resistance were observed during the first 12 months in Yunnan. Methods Selected 140 HW/AIDS patients who didn＇t accept antiviral therapy before. Observed and treated them in 0,6,12 months, detected CD4 plus lymphocyte CD4, virus capacity and drug resistance patients whose VL〉1000copies/ml after treatment. Results The patients＇ CD4 average value was 164/1 before treatment, it rose to 327/1 and 377/1 after 6 months and 12 months treatment. The patients at baseline of VL〈1000copies/ml were 2.1%. The rate rose to 94.7% and 94.4 % after 6 months and 12 months treatment. Main mutational site hadn＇t discovered in the baseline drug resistance test as well as in seven patients whose VL〉1000copies/ml after 6 months treatment, but there were 3 patients appeared varying degrees drug resistance to both NRTI and NNRTI drugs. Conclusions The first-line antiviral therapy project has therapeutic effect to the patients in Yunnan province. 2.4% patients appeared drug resistance after 12 months treatment. It is need to change antiviral therapy plan in time to avoid accumulating drug resistance site and lead to cross drug resistance to insure antiviral therapy efficiency.