艾滋病抗病毒治疗失败患者的耐药情况分析

Analysis of drug resistance in patients with acquired immunodeficiency syndrome who failed antiviral therapy

目的了解艾滋病患者抗病毒治疗失败后的耐药状况。方法纳入2017年10月至2018年12月于郑州市第六人民医院行抗病毒治疗失败的156例艾滋病患者。人类免疫缺陷病毒(human immunodeficiency virus,HIV)-1耐药采用HIV-1 ViroSeq™基因型检测法,与斯坦福大学HIV耐药数据库(http:∥hivdb.stanford.edu/)比对检测结果。结果156例抗病毒治疗失败的艾滋病患者中,有122例(78.21%)发生了耐药。106例(67.95%)对核苷类反转录酶抑制剂耐药,其中对拉米夫定、恩曲他滨、阿巴卡韦3种药物同时耐药的患者104例(66.67%);118例(75.64%)对非核苷类反转录酶抑制剂耐药,对依非韦伦和奈韦拉平同时耐药118例(75.64%);7例(4.49%)对蛋白酶抑制剂耐药。122例耐药患者中,核苷类反转录酶抑制剂耐药位点为16个,M184V/I位点突变次数最高,为87次(71.31%);非核苷类反转录酶抑制剂耐药位点13个,K103N/R位点突变49次(40.16%);蛋白酶抑制剂耐药位点11个,A71V/T位点突变49次(40.16%)。对拉米夫定、恩曲他滨中高度耐药者102例(83.61%),对依非韦伦、奈韦拉平中高度耐药者117例(95.90%),这些药物一旦发生耐药即呈现中度或高度耐药。对齐多夫定、替诺福韦、洛匹那韦/利托那韦中高度耐药者分别为29例(23.77%)、48例(39.34%)、5例(4.10%),这些药物耐药屏障相对较高。结论抗病毒治疗失败的艾滋病患者的耐药发生率高,多重耐药现象严重,且耐药位点存在多样性。

Objective To investigate the drug resistance of patients with acquired immunodeficiency syndrome(AIDS)who failed antiviral therapy.Methods A total of 156 AIDS patients with antiviral therapy failure at the Sixth People′s Hospital of Zhengzhou from October 2017 to December 2018 were selected.The human immunodeficiency virus(HIV)-1 ViroSeq™genotyping method was used for the detection of HIV resistance,and Stanford University HIV drug resistance database(http:∥hivdb.stanford.edu/)was used for testing results comparison.Results Among the 156 AIDS patients with antiviral therapy failure,122(78.21%)developed drug resistance.One hundred and six(67.95%)cases were multi-resistant to nucleoside reverse transcriptase inhibitor(NRTI),among which,104(66.67%)were resistant to lamivudine,emtricitabine and abacavir.One hundred and eighteen(75.64%)were resistant to non-nucleoside reverse transcriptase inhibitor(NNRTI),and 118(75.64%)were multi-resistant to efavirenz and nevirapine.And seven(4.49%)were resistant to protease inhibitor(PI).There were 16 resistant sites for NRTI,with 87(71.31%)most frequent M184V/I mutations.There were 13 resistant sites for NNRTI,with 49(40.16%)K103N/R mutations.There were 11 resistant sites for PI,with 49(40.16%)A71V/T mutations.The antiviral drugs lamivudine and emtricitabine were moderately and highly resistant in 102(83.61%)cases,efavirenz and nevirapine were moderately and highly resistant in 117(95.90%)cases.Once drug resistance developed,these drugs were likely to be moderate or high resistance.There were 29(23.77%),48(39.34%),and five(4.10%)cases were resistant to zidovudine,tenofovir and lopinavir/ritonavir,respectively.The resistance barrier of these drugs was relatively high.Conclusion The incidence of drug resistance in patients with AIDS treatment failure is high,and multi-drug resistance is serious with various sites of drug resistance.