云南省德宏州抗病毒治疗艾滋病患者血浆病毒载量及耐药研究

Study on HIV viral load in plasma and drug resistance among AIDS patients receiving antiretroviral treatment in Dehong prefecture, Yunnan province

目的 了解云南省德宏州艾滋病患者接受抗病毒治疗后HIV病毒抑制率及耐药突变情况.方法 对德宏州截止2012年12月31日入组、抗病毒治疗半年以上、年龄≥15岁的全部在治患者进行血浆HIV病毒载量（VL）检测及耐药相关基因位点突变监测.结果 符合入选标准的病例共4 390例,其中3 964例（90.3％）参加了本研究,2 307例（58.2％）研究对象CD4＋T淋巴细胞计数在350 cells/mm3以上.3 169例（79.9％）研究对象血浆VL低于检测下限.其中,瑞丽市、女性、年龄在45岁以上、已婚、异性传播、治疗时间＞5年、CD4＋T淋巴细胞计数＞500 cells/mm3的患者中血浆VL低于检测下限者所占比例显著高于其他患者,差异有统计学意义.402例（10.1％）患者血浆VL≥1 000 copy/ml,其中353例（87.8％）成功进行了耐药相关基因位点突变检测,并有198例（56.1％）检测发现耐药基因突变,以核苷类反转录酶抑制剂（NRTIs）和非核苷类反转录酶抑制剂（NNRTIs）耐药为主,分别以M184V和K103N突变最为常见.有12例（3.4％）患者存在蛋白酶抑制剂（PI）耐药基因突变.多因素logistic回归分析显示：治疗时间及初始治疗药物组合对耐药发生率的影响有统计学意义.结论 云南省德宏州艾滋病患者接受抗病毒治疗后,HIV抑制率较高,但在病毒抑制效果不好的患者中耐药比例较高,需继续加强抗病毒治疗依从性教育,并及时做好血浆VL检测及耐药监测工作.

Objective To understand HIV rival suppression and drug resistance （HIVDR） among AIDS patients who were receiving antiretroviral treatment （ART） in Dehong prefecture,Yunnan province.Methods All AIDS patients who were aged over 15 years and with experience more than six months on ART by the end of 2012 in Dehong prefecture,were enrolled to receive testing for HIV viral load in plasma and genetic mutations associated with HIVDR.Results A total of 4 390 AIDS patients were qualified for the study according to the selection criteria,of whom 3 964 （90.3%） finally participated in the study.Among them,2 307 （58.2%） had CD4＋ cell counts more than 350 cells/mm3.3 169 （79.9%） patients showed undetectable plasma HIV viral load which was lower than the detection threshold.Those who had the following factors as：resided in Ruili city,being female,older than 45 years of age,married,heterosexually infected with HIV,having received ART more than 5 years,and CD4 ＋ cell counts 〉500 cells/mm3,were more likely to have undetectable plasma virus load,with the differences statistically significant.402 （10.1%） patients had plasma viral load ≥1 000 copies/ml,of whom 353 （87.8%） were successfully amplified and examined for HIVDR.Among them,198 （56.1%） were identified to bear genetic mutations associated with HIVDR.Most mutations were related to the resistance to nucleotide reverse transcriptase inhibitors （NNRTIs） or non-nucleotide reverse transcriptase inhibitors （NNRTIs）,with M184V and K103N most frequently seen.12 patients （3.4%） were found to have mutations resistant to protease inhibitors （PI）.Data from multiple logistic regression analysis indicated that the period of receiving ART and the initial ART regimen could both significantly predict the occurrence of HIV resistance.Conclusion Viral suppression was highly achieved among ART-prescribed AIDS patients in Dehong prefecture,Yunnan province.However,among those who did not show effective viral suppression,the proportion of HIVDR was high,underscoring the needs for health education so as to improve the adherence to drugs as well as for improving testing for viral load and HIVDR among AIDS patients.