吉林省181例病毒学治疗失败的HIV/AIDS患者耐药情况分析

Analysis of drug resistance in 181 HIV/AIDS patients who failed virological treatment in JilinProvince

目的分析吉林省2017—2020年接受抗病毒治疗(ART)发生病毒学治疗失败的艾滋病感染者及病人(HIV/AIDS)患者的耐药情况,为评价艾滋病抗病毒治疗效果提供依据。方法收集中国艾滋病综合防治信息系统中吉林省2017—2020年病毒学治疗失败的HIV/AIDS患者的流行病学调查资料、耐药信息及实验室检测结果,利用SPSS24.0软件分析HIV/AIDS患者的耐药情况。结果共调查181例病毒学治疗失败患者,其中耐药检出率为63.5%(115/181)。诊断时年龄以25~45岁(54.1%)为主,性别以男性(95.6%)为主,患者的体质量指数(BMI)以≤18.4 kg/m^(2)(80.6%)为主,WHO临床分期以Ⅰ期(58.0%)为主,初始治疗方案以一线方案(96.7%)为主,耐药检测时治疗时长以13~36个月(50.8%)为主。首次CD4+T淋巴细胞计数:≤50个/ul占17.7%、51~199个/ul占24.8%、≥200个/ul占57.5%,传播途径以同性传播(66.3%)为主。患者确诊至开始治疗时间间隔<24个月的占81.7%,在治期间未更换治疗方案的占71.8%。单因素分析结果显示:性别、WHO临床分期、初始治疗方案、首次CD4+T淋巴细胞计数、确诊至开始治疗时间、是否更换治疗方案在耐药组与未耐药组间之间比较,均具有统计学差异(χ^(2)=5.365、16.853、10.813、35.633、7.356、18.128,均P<0.05)。研究对象中有49.2%(89/181)表现出对核苷(酸)类反转录酶抑制剂(NRTIs)耐药,其中齐多夫定(AZT)占44.2%、司他夫定(D4T)占35.9%、去羟肌苷(DDI)占3.9%、拉米夫定(3TC)占3.4%、其他药品占32.6%,阿巴卡韦(ABC)、恩曲他滨(FTC)、替诺福韦(TDF)耐药数均为0。有61.3%(111/181)表现出对非核苷类反转录酶抑制剂(NNRTIs)耐药,其中奈韦拉平(NVP)占48.6%、利匹韦林(RPV)占47.0%、依非韦伦(EFV)占45.3%、依曲韦林(ETR)占27.1%、其它药物占1.7%。有1.7%(3/181)表现出对蛋白酶抑制剂(PIs)耐药,其中洛匹那韦+利托那韦(LPV/r)占1.7%、阿扎那韦+利托那韦(ATV/r)占1.1%、达芦那韦+利托那韦(DRV/r)占0.6%。NRTIs+NNRTIs耐药85例,占总体的47.0%(85/181),NRTIs+NNRTIs+PIs耐药3例,占1.7%(3/181)。结论及早发现艾滋病感染者并快速启动抗病毒治疗是降低艾滋病耐药率的有效措施。抗病毒治疗定点医疗机构及疾控中心应做好患者基线实验室检查,提高检测结果的时效性,治疗过程中定期进行耐药及病载检测,及时合理调整抗病毒治疗方案。

Objective To investigate the drug resistance of HIV-infected and human immunodeficiency virus/acquired immune deficiency syndrome(HIV/AIDS)patients who received antiretroviral therapy(ART),but failed virological treatment in Jilin Province from 2017 to 2020,and to provide evidence for evaluating the efficacy of antiretroviral treatment for AIDS.Methods The epidemiological data,drug resistance information and laboratory test results of HIV/AIDS patients who failed virological treatment in Jilin Province from 2017 to 2020 were collected from China AIDS Integrated Prevention and Control Information System,and the drug resistance of HIV/AIDS patients was analyzed by SPSS24.0 software.Results A total of 181 cases were investigated and the detection rate of drug resistance was 63.5%(115/181).The majority of patients were aged 25-45 years(54.1%)and male(95.6%)at the time of diagnosis.The majority of patients had body mass index(BMI)≤18.4 kg/m^(2)(80.6%).The majority of WHO clinical stages were stage I(58.0%),and the primary treatment was first-line regimen(96.7%).The duration of treatment was mainly 13-36 months(50.8%).The first CD4+T lymphocyte count:≤50/ul accounted for 17.7%,51-199/ul accounted for 24.8%,≥200/ul accounted for 57.5%,and the transmission route was mainly homosexual transmission(66.3%).81.7%of the patients had a time interval of less than 24 months from diagnosis to initiation of treatment,and 71.8%of the patients did not change the treatment regimen during treatment.The results of single factor analysis showed that:There were significant differences in gender,WHO clinical stage,initial treatment regimen,first CD4+T lymphoid count,time from diagnosis to initiation of treatment,and whether to change treatment regimen between drug resistant group and non-drug resistant group(χ^(2)=5.365,16.853,10.813,35.633,7.356,18.128,all P<0.05).49.2%(89/181)of the subjects showed resistance to nucleoside(acid)reverse transcriptase inhibitors(NRTIs).Among them,Zidovudine(AZT)accounted for 44.2%,Stavudine(D4T)accounted for 35.9%,deoxyinosine(DDI)accounted for 3.9%,lamivudine(3TC)accounted for 3.4%,and other drugs accounted for 32.6%.The drug resistance of abacavir(ABC),emtricitabine(FTC)and Tenofovir(TDF)were 0.There were 61.3%(111/181)of patients showed resistance to non-nucleoside reverse transcriptase inhibitors(NNRTIs),of which nevirapine(NVP)accounted for 48.6%,Ripiavirin(RPV)accounted for 47.0%,efavirenz(EFV)accounted for 45.3%,Ettriverin(ETR)accounted for 27.1%,and other drugs accounted for 1.7%.1.7%(3/181)showed resistance to protease inhibitors(PIs),of which Lopinavir+ritonavir(LPV/r)accounted for 1.7%,Azanavir+ritonavir(ATV/r)accounted for1.1%,and Darunavir+Ritonavir(DRV/r)accounted for 0.6%.There were 85 NRTIs+NNRTIs drug resistant cases,accounting for 47.0%(85/181)of the total,and 3 NRTIs+NNRTIs+PIs drug resistant cases,accounting for 1.7%(3/181).Conclusion Early detection of HIV infection and rapid initiation of antiviral therapy are effective measures to reduce the rate of drug resistance.The designated medical institutions and CDC for antiviral treatment should conduct baseline laboratory examination of patients,improve the timeliness of test results,conduct regular drug resistance and disease load detection during treatment,and timely and reasonable adjustment of antiviral treatment plan.