AIDS合并结核病患者抗结核联合HAART治疗后HIV基因型耐药研究

Research on HIV genotype drug resistance among AIDS patients complicated with tuberculosis who have accepted anti-tuberculosis treatment and highly active anti-retroviral therapy

目的探讨抗结核治疗联合高效抗反转录病毒治疗（HAART）对AIDS合并结核病（AIDS/TB）患者HIV耐药性的影响。方法 101例AIDS患者（对照组）接受HAART,实验组126例AIDS/TB患者（实验组）抗结核治疗2~8周后开始HAART。监测两组患者的HIV病毒载量及CD4＋T细胞计数,对HIV病毒载量大于1 000拷贝/ml的患者进行基因型耐药检测,比较两组耐药情况及HAART疗效。结果治疗24周时,实验组有7例患者病毒载量大于1 000拷贝/ml,其中1例检测出耐药突变基因,为蛋白酶（PR）基因检测次要耐药位点;对照组有1例病毒载量大于1 000拷贝/ml,但未检出HIV耐药突变基因。两组患者基因型耐药发生率差异无统计学意义（P〉0.05）。两组患者治疗后CD4＋T细胞计数均较治疗前上升,但两组组间治疗前后CD4＋T细胞计数比较,差异均无统计学意义（P〉0.05）。治疗48周时两组患者病毒载量均低于检测下限。结论 AIDS/TB双重感染者同时接受抗结核及HAART,未导致HIV耐药性的产生。

Objective To investigate the HIV drug resistance of AIDS patients complicated with tuberculosis （ AIDS/TB） who have accepted anti-tuberculosis treatment and highly active anti-retroviral therapy（HAART）.Methods One hundred and one AIDS patients in the control group accepted HAART,and 126 AIDS/TB patients in the experimental group accepted HAART after 2 to 8 weeks of anti-tuberculosis treatment.The HIV viral load and CD4＋T lymphocyte count of the patients were monitored in two groups .The drug resistant genotype test was performed among patients with HIV viral load more than 1 000 copies/ml.The result of HIV drug resistant genotype test and the effect of HAART were compared between two groups.Results After a 24-week treatment,the secondary resistance loci of protease （PR） gene was detected in 1 of 7 cases whose HIV viral load more than 1 000 copies/ml in the experimental group.And there was only 1 case whose HIV viral load more than 1 000 copies/ml,but no HIV resistant genotype was detected in the control group .There was no significant difference in the incidence of drug resistant genotype between two groups（P＆gt;0.05）.The CD4＋T lymphocyte count increased after treatment in contrast with that before treatment in two groups,but the CD4＋T lymphocyte count before or after treatment showed no significant difference between two groups（P＆gt;0.05）.The HIV viral load of the patients achieved the undetectable level after a 48-week treatment in two groups.Conclusion HIV drug resistance might not be observed in the AIDS patients complicated with TB who have accepted anti-tuberculosis treatment and HAART at the same time .