获得性免疫缺陷综合征患者原发性基因型耐药情况研究

Primary Genotypic Resistance Drug Situation in AIDS Patients

目的了解医院未经抗逆转录病毒治疗的人类免疫缺陷病毒(HIV)/获得性免疫缺陷综合征(AIDS)患者的HIV原发基因型耐药情况,为临床抗病毒治疗提供治疗依据。方法获取该院HIV病毒聚合酶链式反应(PCR)法成功并得到基因型耐药性结果的病例153份,收集临床资料,分析其对各类抗逆转录病毒药物原发性基因型耐药情况和各类药物交叉耐药情况。结果 153例AIDS患者中,42例(27.45%)有原发性基因型耐药,对蛋白酶抑制剂(PI,3.92%)、核苷类逆转录酶抑制剂(NRTI,5.88%)、非核苷类逆转录酶抑制剂(NNRTI,17.65%)均存在原发耐药,以潜在低度耐药为主。PI药物中,患者对阿托那韦+利托那韦,洛匹那韦+利托那韦,沙奎那韦+利托那韦的原发潜在耐药例数均为3例(1.96%),对福沙那韦+利托那韦,茚地那韦+利托那韦,奈非那韦的原发潜在低度耐药例数均为6例(3.92%),对地瑞那韦+利托那韦,替拉那韦+利托那韦敏感;NRTI药物中,患者对拉米夫定、阿巴卡韦、恩曲他滨、替诺福韦的原发低度耐药例数均为3例(1.96%),对去羟肌苷的原发中度耐药例数为3例(1.96%),对齐多夫定、司他夫定的原发耐药均为6例(3.92%),其中中度耐药3例(1.96%),潜在低耐药3例(1.96%);在NNRTI中,患者对依非韦伦、奈韦拉平的原发潜在低度耐药均为21例(13.73%),对依曲韦林的原发潜在低度耐药24例,对利匹韦林的原发耐药24例,其中潜在低度耐药21例(13.73%),低度耐药3例(1.96%)。NNRTI完全交叉耐药率为77.78%,PI呈部分交叉耐药(100.00%),NRTI存在部分交叉耐药(66.67%)和完全交叉耐药(33.33%)。结论该院HIV原发基因型耐药流行性状态不容乐观,应加强原发耐药检测,为临床抗病毒治疗的药物选择提供参考。

Objective To study the resistance drug situation of AIDS patients without anti- RT virus treatment in the hospital and to provide basis for clinical effective treatment. Methods 153 cases of PCR HIV virus were get successfully and the results of genotypic resistance were analyzed for the primary genotypic resistance situation. Results In the 153 cases of AIDS patients,42 cases（27.45% ） had primary genotypic resistance,patients had primary resistance to protease inhibitor（PI, 3. 92% ）,nucleoside reverse transcriptase in- hibitors（NRTI,5.88% ）,non-nucleoside reverse transcriptase inhibitor（NNRTI, 17.65% ）,all of which were mainly low level resistance to potential main. About PI drugs,there were 3 cases（l. 96% ） to have primary genotypic resistance with ATV/r,LPV/r,SQV/r,there were 6 cases（3.92% ） to have primary genotypic resistance with FPV/r,IDV/r,NFV,DRV/r,TPV/r-sensitive;about NRTI,there were 3 cases（1.96% ） to have primary genotypic low resistance with 3TC,ABC,FTC,TDF,there were 3 cases（1.96% ） to have primary genotypic Intermediate resistance with DDI,there were 6 cases（3.92% ）to have primary genotypic resistance with AZT, D4T,3 cases （1.96%） in intermediate resistance,3 cases（1.96% ） in potential low resistance;about NNRTI,there were 21 cases（13.73% ） of AIDS patients had primary genotypic resistance with EFV, NVP, there were 24 cases to have potential low resistance to ETR, there were 24 cases to have primary genotypic resistance with RPV,21 cases（13.73% ） in potential low resistance,3 cases in low resistance（1.96% ） .The complete cross-resistance to NNRT was 77.78% ,the part of the cross resistance to PI was 100.00% ,there were 66. 67% par- tial cross resistance and 33.33% complete cross-resistance in NRTI. Conclusion The situation of primary genotypic resistance of AIDS patients is not optimistic. The primary drug resistance testing should be strengthen to provide basis for clinical effective treatment.