广西使用阿片类毒品的HIV感染者耐药情况及其影响因素分析

Drug resistance and its influencing factors in HIV-infected patients with opioids drug use in Guangxi

目的探讨广西使用阿片类毒品的HIV感染者基因型耐药情况及耐药的影响因素。方法采用方便抽样的方式,募集使用阿片类毒品的HIV感染者230例,均成功扩增HIV pol区基因片段。分析使用阿片类毒品的HIV感染者耐药发生率、抗病毒药物的耐药情况及耐药位点,采用Logistic回归模型分析耐药的影响因素。结果230例使用阿片类毒品的HIV感染者中36例发生耐药,耐药发生率为15.7%,非核苷类反转录酶抑制剂(NNRTIs)耐药发生率为14.3%,核苷类反转录酶抑制剂(NRTIs)耐药发生率为3.5%,蛋白酶抑制剂(PIs)耐药发生率为1.3%。其中,NNRTIs耐药的相关突变位点主要为E138A、K103N、V106A/I/M,NRTIs耐药的相关突变位点主要为M184V/I,PIs耐药的相关突变位点主要为G73S。多因素Logistic回归分析结果显示,最近一次CD4+T细胞计数≥200个/μL是耐药发生的保护因素,无固定性伴侣是耐药发生的危险因素(均P<0.05)。结论使用阿片类毒品的HIV感染者耐药率处于高度流行水平,以NNRTIs和NRTIs耐药为主。要密切监测吸毒人群的HIV耐药性,及时根据情况调整抗病毒治疗方案来进一步控制HIV耐药的发生。

Objective To investigate the incidence of genotypic resistance and the influencing factors of drug resistance among HIV-infected patients with opioids drug use in Guangxi.Methods A total of 230 HIV-infected patients with opioids drug use were recruited by the convenient sampling method,and the pol gene fragment of HIV was amplified successfully.The incidence rate of drug resistance,resistance condition and resistance sites of antiviral drugs were analyzed in HIV-infected patients with opioids drug use,Logistic regression model was employed to analyze the influencing factors of drug resistance.Results Of the 230 HIV-infected patients with opioids drug use,36 cases developed drug resistance,with an incidence rate of drug resistance of 15.7%,and the incidence rates of resistance to non-nucleoside analog reverse-transcriptase inhibitors(NNRTIs),nucleoside analog reverse-transcriptase inhibitors(NRTIs),and protease inhibitors(PIs)were 14.3%,3.5%and 1.3%,respectively.The major relevant mutation sites for resistance to NNRTIs were E138A,K103N and V106A/I/M,for resistance to NRTIs was M184V/I,and for resistance to PIs was G73S.Multivariate Logistic regression analysis results showed that CD4+T cell count≥200/μL in the last detection was the protective factor for the occurrence of drug resistance,and no regular sex partner was the risk factor for the occurrence of drug resistance(all P<0.05).Conclusion The prevalence of drug resistance among HIV-infected patients with opioids drug use is at a high level,dominated by resistance to NNRTIs or NRTIs.Close monitoring of HIV drug resistance among drug users should be performed,and antiviral treatment protocol should be adjusted promptly in accordance with the situation to further control the occurrence of HIV drug resistance.