泸州市50岁以上艾滋病病毒学失败患者耐药性分析

Analysis on drug resistance in patients over 50 years old who failed with HIV antiviral treatment in Luzhou City

目的分析泸州市50岁以上接受艾滋病抗病毒治疗患者中发生病毒学失败的耐药影响因素和耐药特征,为抗病毒治疗提供参考,提高治疗成功率。方法对2021年泸州市50岁以上接受艾滋病抗病毒治疗且病毒学失败的患者进行HIV-1基因型耐药检测,采用统计学Logistic回归分析病毒学失败患者耐药发生的影响因素,以P<0.05为差异有统计学意义。结果共招募575研究对象,成功获得序列550例(95.65%),其中281例(51.09%)耐药。多因素Logistic回归分析发现,病程为艾滋病患者是HIV感染者的1.49倍(95%CI:1.04~2.61);治疗前CD4^(+)T淋巴细胞计数为>200个/μl组是≤200个/μl组的0.68倍(95%CI:0.47~0.97);治疗时间≥36个月是治疗时间<12个月的1.96倍(95%CI:1.06~3.64);感染CRF08_BC亚型毒株是CRF07_BC亚型毒株的1.71倍(95%CI:1.11~2.65)。耐药突变位点核苷类逆转录酶抑制剂(NRTIs)中的M184V/I和非核苷类逆转录酶抑制剂(NNRTIs)中的K103N、V179D/E、V106M检出率较高。结论泸州市50岁以上艾滋病病毒学失败患者耐药率较高,耐药突变状况复杂多样。其中病程、基线CD4^(+)T淋巴细胞计数、治疗时间和感染毒株亚型是发生耐药的影响因素,只有及时检测,及时调整治疗方案,才能减少耐药率的发生。

Objective To analyze the influencing factors and drug resistance characteristics of patients over 50 years old who failed with HIV antiviral treatment in Luzhou City,so that to provide reference for antiviral treatment and to improve the success rate of treatment.Methods HIV-1 genotype drug resistance was tested in patients with AIDS over 50 years old in 2021,and statistical Logistic regression were used to analyze the occurrence of drug resistance in virological failure patients.The differences P<0.05 was considered statistically significant.Results The 575 patients met the survey criteria,successful sequence acquisition of 550 cases(95.65%).Of these cases,281 patients(51.09%)were drug-resistant.Multivariate Logistic regression analysis found that,the disease course of AIDS patients was 1.49 times higher than that of HIV-infected patients(95%CI:1.04-2.61).Pretreatment CD4 the group of>200(/μl)was 0.68 times of the group of≤200(/μl)(95%CI:0.47-0.97);The treatment duration of the group of≥36 months was 1.96 times of that group<12 months(95%CI:1.06-3.64);The infection of CRF08_BC subtype strain was 1.71 times higher than the infection of CRF07_BC subtype strain(95%CI:1.11-2.65).respectively.Non-nucleoside reverse transcriptase inhibitors(NRNTIs),nucleoside reverse transcriptase inhibitors(NRTIs),and protease inhibitors(PIs)had more resistance mutations at K103N,M184V/I,and M41L,respectively.Conclusions Luzhou HIV patients over 50 years old with viral failure have high drug resistance rate,and drug resistance mutation status is complex and diverse.Disease course,baseline CD4^(+)T lymphocyte count,treatment time and infected strain subtype are the influencing factors of drug resistance.Only the timely detection,timely adjustment of treatment plan can reduce the occurrence of drug resistance rate.