河南省部分地区HIV感染原发耐药状况

The primary HIV drug resistance in partial region of Henan province

目的了解河南省长期抗病毒治疗地区HIV毒株原发耐药现状。方法收集河南省部分早期开展抗病毒治疗地区中未治疗的121例长期HIV感染病例，及154例2011年1月至2012年3月新确证HIV感染病例，进行基本情况问卷调查，同时采集静脉血进行CD4＋T淋巴细胞和病毒载量检测，对病毒载量〉1000拷贝／ml的样本采用in—house方法进行基因型耐药检测，分析两组的人口学特征、免疫学指标及原发耐药情况。结果121例长期感染组均因既往有偿献血途径感染，年龄为（46．61±9．32）岁，感染时间为（12．50±3．21）年。154例新确证组感染途径多样，包括血液传播73例、性传播73例及其他8例，年龄为（22．21±3．11）岁，平均确证时间为（0．91±0．28）年，两组人群在传播途径、年龄和感染时间方面差异有统计学意义（P〈0．05）。长期感染组CD4＋T淋巴细胞的中位数（第25百分位数至第75百分位数）值为322（217～422）个／μl，低于新确证组的434（308～578）个／μl（P〈0．05），两组病毒载量对数值的中位数（第25百分位数～第75百分位数）分别为4．0（2．96～4．64）、3．77（2．94～4．53）拷贝／ml（P〉0．05）。基因型耐药结果表明，长期感染组和新确证组耐药率分别为5．79％（7／121）、9．09％（14／154）（P〈0．05），后者检出1例耐蛋白酶抑制剂（PI）的毒株。结论河南省抗病毒治疗地区未治疗人群存在HIV原发性耐药毒株，早期感染人群和新确证者均存在不同程度的耐药。

Objective To study the prevalence of primary HIV drug resistance in antiretroviral therapy（ART） areas of Henan province. Methods A total of 121 drug-naive long-term infected individuals and 154 patients with newly diagnosed from January 2011 to March 2012 were recruited, the questionnaires were surveyed and whole blood were collected to analyze the CD4 ＋ T cell counts and viral load. In-house method for genotypic resistance test was determined in those with viral load 〉 1000 copies/m1 samples, the differences of demographic characteristics, immunological parameters and primary drug resistance were compared between the two groups. Results A total of 121 cases of long-term individuals who had infected （12. 50±3.21 ） years were mainly previous paid blood donors, and the age was （46. 61±9.32） years old. The infection route of the newly diagnosed were diversity, including blood, sexual transmission and others, the cases were 73, 73, 8, respectively, the confirmatory year was （0. 91±0. 28） years, and average age was （22. 21± 3.11 ） years old. The difference were statistically significant in the route of transmission, age and infection time from demographic analysis of the two groups （ P 〈 0. 05 ）. The absolute M（P25 - P75 ） counts of CD4 ＋ T lymphoeytes of long-term group was 322 （217 - 422） cell/μl, which was lower than the newly diagnosed was 434（ 308 -578 ） cell/μl （P 〈 0.05 ）, and viral load was 4. 0 （2. 96 - 4. 64） copies /ml, 3.77 （ 2. 94 - 4. 53 ） copies/ml, the difference was not significant （ P 〉 0. 05 ）. The prevalence of primary drug resistance in long-term group and newly diagnosed was 5.79% （7/121） , 9. 09% （ 14/154 ）, respectively, and the difference was statistically different（ P 〈 0. 05 ）, and one PI-resistant strain was found in the newly diagnosed group. Conclusion The primary drug resistant strains in untreated patients were found in Henan province of ART areas, and there was difference in degree of resistance between long-term infected individuals and newly diagnosed.