德宏地区艾滋病病人ART后的耐药性观察

Clinical observation of HIV-1 drug-resistance in HIV-infected individuals after antiretroviral therapy in Dehong,Yunnan

目的了解德宏地区艾滋病(AIDS)病人在进行抗反转录病毒治疗(ART)后,发生耐药的情况。方法为德宏地区进行ART的病人检测CD4+T淋巴细胞计数、病毒载量及基因型耐药性,以SPSS 17.0分析病人的耐药数据。结果 78例病人中,男49例,女29例,以汉族(41.0%)和景颇族(34.6%)病人为多,农民占71.8%。随访地点主要在陇川(43.6%)和潞西(37.2%)。性传播、静脉吸毒传播和母婴垂直传播分别占53.8%(42/78)、30.8%(24/78)和15.4%(12/78)。ART 24个月后最常见的核苷类反转录酶抑制剂的耐药突变是M184I/V、D67N/S、T69F和T215F/Y,非核苷类反转录酶抑制剂耐药突变中K101E/I/Q、K103N/R/S/V、Y181C和G190A/S发生率最高,蛋白酶抑制剂耐药突变较少。结论德宏地区AIDS病人ART后出现较多反转录酶耐药位点,ART规范应加强并提高服药依从性。

Objective To investigate drug-resistance of human immunodeficiency virus （HIV） in HIV-infectedindividuals after antiretroviral therapy （ART） in Dehong, Yunnan. Methods Seventy eight HIV-infected individuals treated with ART were enrolled in this study. CD4 counts, HIV viral loads and genotype resistance tests were conducted. Data were analyzed by using SPSS 17.0. Results Of the 78 individuals, 49 were male and 29 were female, and the dominant ethnics were Han （41.0%） and Jingpo （34.6%）. Most of them were farmers （71.8%） who were followed up at the sites of Longchuan （43.6%） and Luxi （37.2%）. Sex transmission, transmission via intravenous drug use and mother to infant vertical transmission accounted for 53.8% （42/78）, 30.8% （24/78） and 15.4% （12/ 78）, respectively. After 24 months of ART, the most common NRTI resistant mutations were M184I/V, D67N/S, T69F and T215F/Y. Among NNRTI mutations, K101E/I/Q, K103N/R/S/V, Y181C and G190A/S represented the highest rate. Only a few mutations were detected in protease region. Conclusions Many reverse transcriptase mutations occurred in patients after ART in Dehong, Yunnan, which reminds us to provide standard ART and enhance drug adherence.