抗病毒治疗前耐药对HIV感染者治疗3年后病毒学应答的影响

Effects of pretreatment HIV drug resistance on the virological response of HIV-infected patients after 3-year antiretroviral therapy

目的:了解抗病毒治疗前耐药对HIV感染者治疗3年后的病毒学应答的影响。方法:2018年对HIV感染者开展抗病毒治疗前耐药基线调查,进行抗病毒治疗3年后随访。通过临床数据和病毒学实验室检测指标进行统计分析。结果:2 433例研究对象中,18~34岁占41.6%(1 012/2 433),男性占82.8%(2 015/2 433),高中及以上占46.9%(1 142/2 433),务农占22.4%(544/2 433),未婚占33.8%(823/2 433),异性性传播占48.1%(1 169/2 433),CRF07_BC亚型占41.3%(1 004/2 433)。抗病毒治疗前耐药率为4.5%(109/2 433)。抗病毒治疗3年后病毒学抑制失败率(病毒载量≥50拷贝数/ml)和耐药率分别为8.1%(196/2 433)和2.5%(60/2 433),其中抗病毒治疗前耐药和不耐药的病毒学抑制失败率分别为18.3%(20/109)和7.6%(176/2 324)、耐药率分别为4.6%(5/109)和2.4%(55/2 324)。多因素logistic回归模型分析结果显示,抗病毒治疗前耐药对HIV感染者治疗3年后的病毒学抑制失败的影响因素包括文盲(a OR=3.26,95% CI:1.82~5.86)、小学/初中(a OR=1.54,95% CI:1.09~2.18)、抗病毒治疗3年后CD4 +T淋巴细胞计数<200个/μl和200~499个/μl(a OR=2.77,95% CI:1.75~4.37;a OR=1.55,95% CI:1.10~2.18)、最近1个月漏服抗病毒治疗药物(a OR=4.24,95% CI:2.92~6.17)和抗病毒治疗前耐药(a OR=2.84,95% CI:1.67~4.85)。 结论:我国HIV感染者抗病毒治疗前耐药处于低流行水平,抗病毒治疗3年后病毒学抑制失败率较高。建议加强HIV感染者的耐药监测,重视抗病毒治疗前耐药对抗病毒治疗效果的影响。

Objective To investigate the impact of pretreatment drug resistance(PDR)on virological effect among HIV-infected patients having received antiretroviral therapy(ART)after three years.Methods The baseline survey of PDR among HIV-infected patients was conducted in 2018,with a three-year follow up study.The clinic data and virological laboratory test variables were statistically analyzed.Results Of the 2433 participants,41.6%(1012/2433)were aged between 18 and 34,82.8%(2015/2433)were males,46.9%(1142/2433)had education of high school or above,22.4%(544/2433)were farmers,33.8%(823/2433)were unmarried,48.1%(1169/2433)were infected heterosexually and 41.3%(1004/2433)were with CRF07_BC.The prevalence of PDR was 4.5%(109/2433).The prevalence of virological suppression failure(viral load≥50 copies/ml)and drug resistance at three years follow up after ART was 8.1%(196/2433)and 2.5%(60/2433)respectively.The prevalence of virological suppression failure and drug resistance at three years follow up after ART were 18.3%(20/109)and 7.6%(176/2324),and 4.6%(5/109)and 2.4%(55/2324)among participants with PDR and non-PDR,respectively.The results of multivariate logistic regression model showed that illiteracy(aOR=3.26,95%CI:1.82-5.86),primary and junior high school education(aOR=1.54,95%CI:1.09-2.18),CD4+T lymphocyte count<200/μl(aOR=2.77,95%CI:1.75-4.37)and CD4+T lymphocyte count 200-499/μl(aOR=1.55,95%CI:1.10-2.18)at a three year follow up visit after ART,missed drugs in the past month(aOR=4.24,95%CI:2.92-6.17),and PDR(aOR=2.84,95%CI:1.67-4.85)were statistically significant with virological suppression failure on treatment.Conclusions The prevalence of PDR in China at a low level currently,and the virological suppression failure rate is low after three years of ART.It is necessary to strengthen drug resistance monitoring of HIV-infected patients and pay attention to the influence of PDR on treatment effect.