昆明地区HIV感染高效抗病毒治疗后基因型耐药分析

Analysis of drug- resistance in HIV patients treated with antivirus- therapy in Kunming

目的分析昆明地区抗病毒治疗失败艾滋病患者的耐药突变特征及相关影响因素。方法对2012年间在我院进行艾滋病抗病毒治疗满半年以上,病毒量检测大于1 000拷贝/ml并成功扩增样本的63例患者,进行血清的基因型耐药检测,对所得到的HIV-1耐药基因突变情况与患者的性别、感染途径、治疗前CD+4T淋区细胞的计数,抗病毒治疗时间等因素,进行统计学分析。结果其检测出耐药突变33例,占52.3%(33/63)。其中32例对核苷类及非核苷类药物耐药(50%),1例对蛋白抑制剂耐药(1.5%),7例对所有核苷类及非核苷类逆转录酶抑制剂耐药,1例对所有核苷类,非核苷类逆转录酶抑制剂及蛋白酶抑制剂耐药,6例出现对蛋白酶抑制剂的其他耐药突变。治疗前CD4+T淋巴细胞计数<200个/μl患者的耐药发生率大于CD4+T淋巴细胞计数>200个/μl的患者,其差异有统计学意义(P=0.000)。治疗时间<12个月的患者耐药发生率低于治疗>12月的患者,其差异有统计学意义(P=0.01)。结论昆明地区抗病毒治疗后产生耐药的艾滋病患者中有20%同时出现对核苷类及非核苷类逆转录酶抑制剂的耐药,这部分患者将面临三线药物的使用问题,应该考虑启用三线药物。早治疗和治疗后的耐药监测是治疗成功的关键。

objective To analyze the characteristics and related impact factors of mutative drug-resistance among HIV/AIDS received ineffective HAART in Kunming. Methods 63 cases of HIV/AIDS patients with viral load over 1000eopy/ml who received HAART more than 6 months were accepted in the experiment. The drug-resistance genes were tested in blood sample. Then the mutative HIV-1 drug-resistance genes, together with patients＂ gender, route of being infected, CD4 ＋ cell counts before treatment and duration of treatment, were statistically analyzed. Results 33 cases were found drug-resistance mutation in serum, which account for 52.3% （33/63）. 32 cases （account for 50% ） are resistant to NRTIs or NNRTIs, 1 case （account for 1.5% ） was resistant to PI, 7 patients were resistant to both NRTI and NNRTI, only 1 patient was resistant to all of the NRTI, NNRTI and PI, 6 patients were found to have other resistant mutations for PI group. The drug-resistance rate of patients with CD4 less than 200 copy/ul before HAART treatment was higher than that of patients with CD4 more than 200 copy/ul （ PA = 0. 000）. The drug-resist- ance rate of patients with HAART duration less than 12 months was lower than that of patient with RT duration more than 12 months （P = 0.01 ）. Conclusion 20% of HIV/AIDS patients in Kunming are resisitant to both NRTI or NNRTI after HAART. They should be considered to be applied with antiviral therapy of the third level. Early HAART and drug-resistantce surveillance after treatment are the key points to ensure effective treatment.