2016-2018年四川省达州市HIV抗病毒治疗情况及耐药性分析

Analysis of HIV Antiretroviral Treatment and Drug Resistance in Dazhou City of Sichuan Province From 2016 to 2018

目的了解2016-2018年四川省达州市HIV抗病毒治疗效果影响因素和耐药情况。方法以2016-2018年达州市接受高效抗逆转录病毒治疗(HAART)1年以上且进行HIV-1病毒载量(VL)检测的HIV/AIDS患者作为研究对象,对VL≥1 000 cps/ml进行耐药检测,计算病毒抑制失败率和耐药率,采用趋势卡方检验分析2016-2018年病毒抑制失败率变化趋势,采用Logistic回归分析病毒抑制失败的影响因素,并分析病毒抑制失败人群的耐药突变等情况。结果 2016-2018年,达州市病毒抑制失败率分别为10.25%、11.16%、9.74%,耐药率分别为4.29%、2.36%和4.32%。多因素Logistic回归分析,性别、文化程度、感染途径、治疗时间和初始治疗方案对抗病毒治疗效果均有统计学意义(P<0.05)。3 038例研究对象中,392例VL≥1 000 cps/ml,329例(83.93%)成功获得基因序列,其中151例(45.90%)发生耐药,149例(45.29%)对非核苷类反转录酶抑制剂(NNRTIs)耐药,104例(31.61%)对核苷类反转录酶抑制剂(NRTIs)耐药;使用含TDF的初始治疗方案耐药率低于含AZT或D4T的初始治疗方案;CRF01AE耐药率高于其他亚型毒株。结论 2016-2018年全市病毒抑制失败率和耐药率总体处于较低水平;女性、小学及以上文化程度、男男性传播途径、治疗满12个月和使用含TDF治疗方案的人群病毒抑制失败率相对较低,病毒抑制失败人群中,使用含TDF方案耐药率相对较低,CRF01AE耐药率相对较高。

Objective To study the influencing factors and drug resistance of HIV antiretroviral treatment in Dazhou of Sichuan Province from 2016 to 2018. Methods HIV/AIDS patients who had received highly active antiretroviral therapy(HAART) more than 1 year and had detected HIV-1 viral load(VL) in Dazhou City from 2016 to 2018 were selected. Drug resistance tests were performed on samples with VL≥1 000 cps/ml,then the failure rate of virus inhibition and the rate of virological resistance were calculated.Cochran Armitage trend test was used to analyze the trend of the failure rate of virus inhibition from 2016 to 2018, and logistic regression model was employed to analyze the influencing factors of the failure of virus inhibition. Results The failure rates of virus inhibition was 10.25% in 2016,11.16% in 2017,and 9.74% in 2018,and the rates of virological resistance were 4.29% in 2016,2.36% in 2017,and 4.32% in 2018 in Dazhou City. Multivariate logistic regression analysis showed that gender, education level, route of infection, treatment duration and initial treatment regimen had statistically significant effect on the antiretroviral treatment(P<0.05). Among 3 038 patients,392 had the VL≥1 000 cps/ml. Further,329(83.93%) obtained gene sequences successfully and 151(45.90%) had drug resistance. There were 149(45.29%) cases resistant to non-nucleoside reverse transcriptase inhibitors(NNRTIs), and 104(31.61%) cases were resistant to nucleoside reverse transcriptase inhibitors. The drug resistance rate of initial treatment regimen containing TDF was lower than that containing AZT or D4 T. Additionally, the drug resistance rate of CRF01AE was higher than other subtypes. Conclusion The failure rate of virus inhibition and the rate of drug resistance were at a low level in Dazhou City from 2016 to 2018. The failure rate of virus inhibition was relatively low in women and the male-male transmission route and the patients with primary school education and above, the treatment more than 12 months and TDF treatment regimens. Among the patients who failing viral inhibition therapy,the drug resistance rate of initial treatment regimen containing TDF was relatively low, whereas the subtype of CRF01AE was relatively high.