山东省抗病毒治疗的HIV/AIDS病人的耐药调查结果分析

Analysis of drug resistance among HIV/AIDS receiving antiretroviral treatment in Shandong province

目的了解山东省抗病毒治疗的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人的耐药发生情况,探讨其可能的影响因素。方法以2013至2014年山东省进行了耐药检测且能随访到的15岁以上的HIV感染者/AIDS耐药病人作为耐药组,在同县(市、区)选择接受抗病毒治疗的病人为对照组。对耐药组和对照组病人进行问卷调查,结合耐药检测结果,分析耐药发生情况及其可能的影响因素。结果共获得有效问卷241份,其中耐药组100份,对照组141份。经比较,耐药组和对照组病人的年龄、性别、婚姻状态、文化程度等一般人口学特征差异无统计学意义,多因素分析显示:治疗时长(月)、基线CD4+T淋巴细胞水平、最近一个月是否漏服、是否有服药监督员与耐药发生有关。耐药组中发生核苷类反转录酶抑制剂(NRTIs)类药物耐药3例,非核苷类反转录酶抑制剂(NNRTIs)类药物耐药27例,NRTIs类和NNRTIs类药物均发生耐药69例,同时发生NRTIs类、NNRTIs类和蛋白酶抑制剂(PI)类药物耐药1例。结论依从性和治疗时机与耐药发生有关。应进一步扩大检测,早发现早治疗,保持高度依从性,以保障抗病毒治疗的效果。

Objective To understand the situation of drug resistance among HIV/AIDS（acquired immune deficiency syndrome） patients receiving antiretroviral treatment（ART） in Shandong province,and to assess the interrelated risk factors.Methods HIV/AIDS patients receiving ART got drug resistance detection from 2013 to 2014.Those with drug assistance who could be followed up and aged 15 years or above formed the case group and those without drug resistance undergoing ART in the same county（city,area） was regarded as a control group.Questionnaire survey was conducted to know the drug resistance and its influencing factors.Results 241 HIV/AIDS receiving ART were surveyed,with 100 in the case group,and 141 in the control group.There was no statistically significant difference in their demographic characteristics between the two groups.The treatment duration and baseline CD4＋ lymphaytes level were associated with drug resistance.Whether there was a supervisor for the medication or occurrence of missing drugs in the last month were the influence factors.3 cases had resistance to NRTIs;27 cases to NNRTIs;and 69 cases to both NRTIs and NNRTIs.Only one case showed resistance to NRTIs,NNRTIs and PI.Conclusion Compliance and time to start ART were associated with drug resistance.Expansion of HIV testing,timely initiation of ART and high compliance are the key measures to improve the effect of ART.