云南省2012年人类免疫缺陷病毒感染者和艾滋病患者抗病毒治疗失败基因型耐药情况分析

Analysis of human immunodeficiency virus genotypic drug resistance among human immunodeficiency virus infection and acquired immune deficiency syndrome individuals with virological failure after free antiretroviral therapy in Yunnan Province in 2012

目的 了解2012年云南省抗病毒治疗病毒学失败的HIV感染者和艾滋病患者（HIV/AIDS）中HIV-1耐药发生情况及特点.方法 收集云南省2012年接受免费HAART的HIV/AIDS患者的临床及实验室资料,对抗病毒治疗持续6个月以上、病毒载量≥1 000拷贝/mL的患者进行基因型耐药检测,分析耐药发生情况及耐药毒株流行特点.分类资料用频数或百分数表示.结果 2012年接受HAART的患者共31 731例,其中1 315例患者发生病毒学失败.1 315例抗病毒治疗病毒学失败的患者中耐药基因突变者775例,占病毒学失败患者的58.9％ （775/1 315）,占抗病毒治疗总体人群的2.4％（775/31 731）.耐药突变位点主要为M184V/I（29.1％）、K103N/S （23.7％）、G190A/S/E（13.5％）、Y181C/I/V（11.8％）和V179D/E/F（9.6％）.使用过的药物中,对奈韦拉平、依非韦仑高度耐药的构成比分别是46.5％（612/1 315）、32.6％（429/1 315）;对拉米夫定、齐多夫定、司他夫定、替诺福韦高度耐药的构成比分别是29.3％（385/1 315）、5.2％（68/1 315）、5.0％（66/1 315）、0.9％（12/1 315）;对洛匹那韦/利托那韦高度耐药的构成比为0.2％（2/1 315）.结论 当前HIV耐药是导致抗病毒治疗失败的主要原因,在以后艾滋病防控中如何避免HIV-1耐药的发生与耐药毒株的传播显得尤为重要.

Objective To investigate the prevalence and characteristics of human immunodeficiency virus （HIV）-1 drug-resistance among the HIV infection and acquired immune deficiency syndrome （HIV/AIDS） individuals with virological failure after national antiretroviral therapy in Yunnan Province in 2012.Methods Clinical and laboratory data of HIV/AIDS cases receiving national free highly active antiretroviral therapy （HAART） in 2012 were collected.HIV-1 genotypic drug resistance testing was performed in patients with the plasma viral loads over 1 000 copy/mL after antiretroviral therapy beyond 6 months.Prevalence and the characteristics of HIV-1 drug resistance were analyzed.Results A total of 1 315 cases suffered from virological failure among 31 731 cases who received HAART in 2012.The rates of drug-resistance gene mutation were 2.4％ （775/31 731） in patients receiving HAART and 58.9％ （775/1 315） in patients with virological failure.The sites of gene mutation were M184V/I （29.1％）,K103N/S（23.7％）,G190A/S/E （13.5％）,Y181C/I/V （11.8％） and V179D/E/F （9.6％）.The percentages of high resistance to nevirapine,efavirenz,lamivudine,zidovudine,stavudine and tenofovir were 46.5％（612/1 315）,32.6％ （429/1 315）,29.3％ （385/1 315）,5.2％ （68/1 315）,5.0％（66/ 1 315） and 0.9％ （12/1 315）,respectively.The percentage of high resistance to lopinavir/ritonavir was 0.2％（2/1 315）.Conclusions At present,the HIV-1 drug resistance is the main cause for virological failure.It is important to reduce the incidence of drug resistance and the spread of drug resistant strains during HIV/AIDS control.