Research progress in urinary tract infection and its therapeutic drugs

Objective: The objective of this study was to understand the pathological mechanism and therapeutic progress in the study of urinary tract infections to provide references for clinical diagnosis and identification and development of therapeutic drugs.Methods: We summarized the types, pathological mechanisms, and therapeutic drugs for urinary tract infections on the basis of recent publications on these infections, both domestic and abroad.Results and conclusions: Urinary tract infection is mainly caused by pathogenic bacterial infection and treated by targeting bacterial adhesion, bacterial toxin, protease, urease, and siderophores, as well as using pili as vaccines and small-molecule drugs. Vaccines that target bacterial adhesion can block well the interaction between pathogens and the body, thereby reducing the incidence of urinary tract infections. The clinical efficacy of vaccines targeting bacterial toxins and proteases needs further evaluation. Vaccines targeting iron carriers retard disease progression and attenuate bacterial colonization. Urease-targeted small-molecule drugs exhibit certain curative effects and serious side effects. Small pili-targeted drugs can prevent and treat urinary tract infections by blocking the colonization and invasion of pathogens in animal models of urinary tract infections on the bladder. Adhesive FimH antibodies have entered Phase Ⅰ clinical trials. However, pilicides, mannosides, and vaccines that target pili, iron carriers, and other virulence factors are still in the experimental or preclinical stages of research.

Current therapeutic strategies for recurrent hepatitis B virus infection after liver transplantation

Hepatitis B virus (HBV)-related liver disease is the leading indication for liver transplantation (LT) in Asia,especially in China.With the introduction of hepatitis B immunoglobulin (HBIG) and oral antiviral drugs,the recurrent HBV infection rate after LT has been evidently reduced.However,complete eradication of recurrent HBV infection after LT is almost impossible.Recurrent graft infection may lead to rapid disease progression and is a frequent cause of death within the fi rst year after LT.At present,the availability of new oral medications,especially nucleoside or nucleotide analogues such as adefovir dipivoxil,entecavir and tenofovir disoproxil fumarate,further strengthens our ability to treat recurrent HBV infection after LT.Moreover,since combined treatment with HBIG and antiviral agents after liver re-transplantation may play an important role in improving the prognosis of recurrent HBV infection,irreversible graft dysfunction secondary to recurrent HBV infection in spite of oral medications should no longer be considered an absolute contraindication for liver re-transplantation.Published reviews focusing on the therapeutic strategies for recurrent HBV infection after LT are very limited.In this article,the current therapeutic strategies for recurrent HBV infection after LT and evolving new trends are reviewed to guide clinical doctors to choose an optimal treatment plan in different clinical settings.

Management of psoriasis patients with hepatitis B or hepatitis C virus infection

The systemic therapies available for the management of Psoriasis (PsO) patients who cannot be treated with more conservative options, such as topical agents and/or phototherapy, with the exception of acitretin, can worsen or reactivate a chronic infection. Therefore, before administering immunosuppressive therapies with either conventional disease-modifying drugs (cDMARDs) or biological ones (bDMARDs) it is mandatory to screen patients for some infections, including hepatitis B virus (HBV) and hepatitis C virus (HCV). In particular, the patients eligible to receive an immunosuppressive drug must be screened for the following markers: antibody to hepatitis B core, antibody to hepatitis B surface antigen (anti-HBsAg), HBsAg, and antibody to HCV (anti-HCV). In case HBV or HCV infection is diagnosed, a close collaboration with a consultant hepatologist is needed before and during an immunosuppressive therapy. Concerning therapy with immunosuppressive drugs in PsO patients with HBV or HCV infection, data exist mainly for cyclosporine a (CyA) or bDMARDs (etanercept, adalimumab, infliximab, ustekinumab). The natural history of HBV and HCV infection differs significantly as well as the effect of immunosuppression on the aforementioned infectious diseases. As a rule, in the case of active HBV infection, systemic immunosuppressive antipsoriatic therapies must be deferred until the infection is controlled with an adequate antiviral treatment. Inactive carriers need to receive antiviral prophylaxis 2-4 wk before starting immunosuppressive therapy, to be continued after 6-12 mo from its suspension. Due to the risk of HBV reactivation, these patients should be monitored monthly for the first 3 mo and then every 3 mo for HBV DNA load together with transaminases levels. Concerning the patients who are occult HBV carriers, the risk of HBV reactivation is very low. Therefore, these patients generally do not need antiviral prophylaxis and the sera HBsAg and transaminases dosing can be monitored every 3 mo. Concerning PsO patients with chronic HCV infection their management with immunosuppressive drugs is less problematic as compared to those infected by HBV. In fact, HCV reactivation is an extremely rare event after administration of drugs such as CyA or tumor necrosis factor-α inhibitors. As a rule, these patients can be monitored measuring HCV RNA load, and ALT, aspartate transaminase, gamma-glutamyl-transferase, bilirubin, alkaline phosphatase, albumin and platelet every 3-6 mo. The present article provides an updated overview based on more recently reported data on monitoring and managing PsO patients who need systemic antipsoriatic treatment and have HBV or HCV infection as comorbidity.

Therapeutic and prevention strategies against human enterovirus 71 infection

Human enterovirus 71(HEV71) is the cause of hand,foot and mouth disease and associated neurological complications in children under five years of age.There has been an increase in HEV71 epidemic activity throughout the Asia-Pacific region in the past decade,and it is predicted to replace poliovirus as the extant neurotropic enterovirus of highest global public health significance. To date there is no effective antiviral treatment and no vaccine is available to prevent HEV71 infection. The increase in prevalence, virulence and geographic spread of HEV71 infection over the past decade provides increasing incentive for the development of new therapeutic and prevention strategies against this emerging viral infection. The current review focuses on the potential, advantages and disadvantages of these strategies. Since the explosion of outbreaks leading to large epidemics in China, research in natural therapeutic products has identified several groups of compounds with anti-HEV71 activities. Concurrently, the search for effective synthetic antivirals has produced promising results. Other therapeutic strategies including immunotherapy and the use of oligonucleotides have also been explored. A sound prevention strategy is crucial in order to control the spread of HEV71. To this end the ultimate goal is the rapid development, regulatory approval and widespread implementation of a safe and effective vaccine. The various forms of HEV71 vaccine designs are highlighted in this review. Given the rapid progress of research in this area, eradication of the virus is likely to be achieved.

Low eradication rate of Helicobacterpyloriwith triple 7-14 days and quadriple therapy in Turkey

AIM:The eradication rate of Helicobacter pylori (H pylori) shows variation among countries and regimens of treatment. We aimed to study the eradication rates of different regimens in our region and some factors affecting the rate of eradication. METHODS:One hundred and sixty-four H pylori positive patients (68 males,96 females;mean age:48±12 years) with duodenal or gastric ulcer without a smoking history were included in the study.The patients were divided into three groups according to the treatment regimens.Omeprazole 20mg,clarithromycin 500mg,amoxicillin 1g were given twice daily for 1 week (Group Ⅰ) and 2 weeks (Group Ⅱ). Patients in Group Ⅲ received bismuth subsitrate 300mg, tetracyline 500mg and metronidazole 500mg four times daily in addition to Omeprazole 20mg twice daily.Two biopsies each before and after treatment were obtained from antrum and corpus,and histopathologically evaluated. Eradication was assumed to be successful if no H pylorus was detected from four biopsy specimens taken after treatment.The effects of factors like age,sex,H pylori density on antrum and corpus before treatment,the total H pylori density,and the inflammation scores on the rate of H pylori eradication were evaluated. RESULTS:The overall eradication rate was 42%.The rates in groups Ⅱ and Ⅲ were statistically higher than that in group Ⅰ (P<0.05).The rates of eradication were 24.5%, 40.7% and 61.5% in groups Ⅰ,Ⅱ and Ⅲ,respectively.The eradication rate was negatively related to either corpus H pylori density or total H pylori density (P<0.05).The median age was older in the group in which the eradication failed in comparison to that with successful eradication (55 yr vs 39 yr,P<0.001).No correlation between sex and H pylori eradication was found. CONCLUSION:Our rates of eradication were significantly lower when compared to those reported in literature.We believe that advanced age and high H pylori density are negative predictive factors for the rate of H pylori eradication.

Azithromycin in a triple therapy for H.pylori eradication in active duodenal ulcer

AIM:To assess and compare the efficacy and safety of two triple regimes:A)metronidazole,amoxicillin and omeprazole, which is still widely used in Russia,and B)azithromycin, amoxicillin and omeprazole in healing active duodenal ulcer and H.pylori eradication. METHODS:100 patients with active duodenal ulcer were included in the open,multicentre,randomized study with comparative groups.Patients were randomly assigned to one of the following one-week triple regimes:A) metronidazole 500 mg bid,amoxicillin I g bid and omeprazole 20 mg bid(OAM,n=50)and B)azithromycin 1 god for the first 3 days(total dose 3 g),amoxicillin 1 g bid and omeprazole 20 mg bid(OAA,n=50).Omeprazole 20 mg od was given after the eradication course as a monotherapy for three weeks.The control endoscopy was performed 8 weeks after the entry.H.pyloriinfection was determined in the entry of the study and four weeks after the cessation of treatment by means of histology and CLO-test. RESULTS:97 patients completed the study according to the protocol(1 patient of the OAM group did not come to the control endoscopy,2 patients of the OAA group stopped the treatment because of mild allergic urticaria).Duodenal ulcers were healed in 48 patients of the OAM group(96 %, C190.5-100 %)and in 46 patients of the OAA group(92 %, CI 89.5-94.5 %)(p=ns).H.pyloHinfection was eradicated in 15 out of 50 patients with OAM(30 %,CI 17-43 %)and in 36 out of 50 patients treated with OAA(72 %;CI 59-85 %) (P<0.001)-ITT analysis.CONCLUSION: The triple therapy with omeprazole, amoxicillin and metronidazole failed to eradicate H.pylori'vc\ the majority of patients, which is an essential argument to withdraw this regimen out of the national recommendations. Macrolide with amoxicillin are preferable to achieve higher eradication rates. Azithromycin (1 g od for the first 3 days) can be considered as a successful component of the triple PPI-based regimen.

SEN virus does not affect treatment response in hepatitis C virus coinfected patients but SEN virus response depends on SEN virus DNA concentration

AIM: To clarify the effect of SEN virus (SENV) infection on a combination therapy including interferon alfa (IFN-α) or pegylated-IFN with ribavirin in patients with chronic hepatitis and the effect of a combination therapy on SENV.METHODS: SENV DNA was determined by polymerase chain reaction in serum samples from 95 patients with chronic hepatitis C. Quantitative analysis was done for SENV H DNA.RESULTS: Twenty-one (22%) of 95 patients were positive for SENV DNA. There was no difference in clinical and biochemical parameters between patients with HCV infection alone and coinfected patients. The sustained response rate for HCV clearance after combination therapy did not differ between patients with SENV (52%) and without SENV(50%, n.s.). SENV DNA was undetectable in 76% of the initially SENV positive patients at the end of follow-up. SENV H response to combination therapy was significantly correlated with SENV DNA level (P=-0.05).CONCLUSION: SENV infection had no influence on the HCV sustained response rate to the combination therapy.Response rate of SENV to the combination therapy depends on SENV DNA level.

Randomized clinical study of five days apostrophe therapy with mebendazole compared to quinacrine in the treatment of symptomatic giardiasis in children

AIM： To compare the efficacy and safety of five days apostrophe therapy of mebendazole （MBZ） versus quinacrine （QC） on human giardiasis in children.METHODS： A clinical trial was carried out in paediatric patients （aged 5-15 years） with confirmed symptomatic G. duodenalis mono-infection. Patients were randomly assigned to receive either MBZ [200 mg taken three times per day GRID） （n = 61）] or QC [2 mg/kg bodyweight tid （n = 61）], both for five days. Follow-up faecal samples were obtained at 3, 5 and 7 d after the end of the treatment.RESULTS： Although the frequency of cure was higher for QC （83.6%） than for MBZ （78.7%）, the difference was not statistically significant （P 〉 0.05）. Adverse events were reported more in the QC group （P 〈 0.05）, all of them transient and self-limiting.CONCLUSION： Despite final cure rates ocurring lower than expected, the overall results of this study reconfirmed the efficacy of MBZ in giardiasis and also indicate that, although comparable to QC, at least in this setting the 5 d course of MBZ did not appear to improve the cure rates in this intestinal parasitic infection.

造血干细胞移植后并发阿萨希毛孢子菌血流感染1例并文献复习

目的:探讨血液恶性肿瘤患儿造血干细胞移植后发生阿萨希毛孢子菌血流感染的治疗药物选择。方法:分析1例造血干细胞移植后处于免疫抑制状态下血流感染阿萨希毛孢子菌的病例资料,结合既往文献,讨论并分析阿萨希毛孢子菌血流感染的药物治疗方案。结果:患儿在艾沙康唑治疗过程中发生了阿萨希毛孢子菌血流感染,调整为伏立康唑和两性霉素B脂质体联合治疗后,体温恢复正常,炎性指标好转,但由于患儿移植后出现了严重的肺部排斥反应,肺出血未能得到有效控制,最终放弃治疗。结论:血液恶性肿瘤患儿血流感染阿萨希毛孢子菌病死率高,在临床实践中应结合病情、体外药敏试验结果选择单药或联合治疗。阿萨希毛孢子菌应首选唑类药物,体外活性最强的是伏立康唑。两性霉素B抗真菌活性不充分,但与伏立康唑的联合治疗方案可能较伏立康唑单药或艾沙康唑单药治疗更具优势。

抗新型冠状病毒小分子药物临床应用专家共识

新型冠状病毒(新冠病毒)感染虽已不再构成“国际关注的突发公共卫生事件”,但仍在全球范围内处于低水平流行。小分子口服药物是我国目前推荐的针对新冠病毒感染的主要抗病毒治疗方案。虽然国内已上市多种抗新冠病毒小分子药物,但目前尚无针对特殊人群的具体用药推荐。中华医学会细菌感染与耐药防治分会联合国家呼吸医学中心、国家呼吸系统疾病临床医学研究中心组织国内呼吸、病毒学、感染、重症、急诊、药学等各领域专家制订了本共识。本共识的主要内容包括7种抗新冠病毒小分子药物介绍,重点阐述了老年人群、合并慢性疾病人群、肿瘤患者、孕妇、儿童等14种特殊人群用药推荐,为临床医师规范用药提供建议。

乙型肝炎病毒感染机制和药物治疗的研究进展

乙型肝炎病毒感染成为全球疾病负担重要原因之一,目前仍缺乏彻底根治的方法。近年来,各类研究分别从抗病毒治疗和增强宿主免疫应答两方面进行药物设计,使得乙型肝炎病毒感染治疗领域快速发展。通过梳理相关文献,本文较为系统、全面地探讨了乙型肝炎病毒的感染机制和药物治疗进展。本文表明,在抗病毒治疗过程中,核苷(酸)类似物、核衣壳组装调节剂、HBx蛋白抑制剂、核糖核酸酶H抑制剂、NTCP相关抑制剂、HBsAg释放抑制剂等药物的设计与病毒生命周期的潜在靶点环环相扣,治疗关键在于彻底清除共价闭合环状DNA病毒源库;在增强宿主免疫应答过程中,通过包括免疫检查点抑制剂、Toll样受体激动剂和干扰素制剂修复和增强患者受损的免疫应答机制,实现抑制病毒复制的治疗目标。总之,乙肝病毒感染的药物治疗之路不断向前发展中。本文以期能够为该领域的研究提供一定思路。

1例药物超敏反应综合征合并多脏器衰竭行连续性肾脏替代治疗的护理

本文总结1例以中毒性表皮坏死松解症为表现特征的药物超敏反应综合征样皮炎合并多脏器衰竭患者行连续性肾脏替代治疗(CRRT)的护理经验。患者病情复杂,入院后积极完善评估和检查,采取CRRT治疗,同时加强脏器衰竭护理、CRRT护理、管路护理、皮肤护理,做好饮食指导和健康宣教,积极预防并发症,患者的皮损明显减轻,生命体征相对恢复稳定。

Effect of drug therapies on self-reported chemosensory outcomes after COVID-19

Objective:The aim of this study was to assess the relative efficacy of medications used following severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection on self-reported alterations in taste and/or smell function.Methods:Seven hundred and fourteen persons with self-reported postcoronavirus disease 2019(post-COVID-19)chemosensory disorders were personally interviewed regarding specific medications they were administered following the acute phase of the disease.The dependent measure—self-reported total recovery of chemosensory symptoms—was subjected to stepwise logistic regression.Independent predictors included demographic and clinical variables,in addition to specific medications used to mitigate disease symptoms(i.e.,systemic corticosteroids,oseltamivir,vitamin C,ibuprofen,hydroxychloroquine,azithromycin,ivermectin,nitazoxanide,anticoagulants,and zinc).Results:The median time between COVID-19 symptom onset and the interviews was 81 days(interquartile range:60-104).Of the 714 subjects,249(34.9%)reported total recovery of their chemosensory function;437(61.2%)had at least one treatment since the beginning of the disease.Women and those with more comorbidities had undergone more treatments.The recovery rates of the treated and nontreated groups did not differ significantly.Nonetheless,respondents who had used nitazoxanide tended to have a higher rate of self-reported taste or smell recovery.Those who took oral zinc were less likely to improve.Conclusions:No medication employed during the first months after SARS-CoV-2 infection had a clear positive effect on returning self-reported smell or taste function to normal,although nitrazoxide trended in a positive direction.Oral zinc had a negative effect on the reported recovery of these senses.

Treatment of Recurrent Respiratory Infection with Chinese Drug Therapy of Tonifying-Shen(肾) and Solidifying Superficiality—A Clinical Case Report

Children recurrent respiratory infection （CRRI） indicates that children suffer from frequent infections along the upper or lower respiratory tract for a certain number of times. It is not an independent disease but a clinical syndrome mostly brought about by some basic diseases such as nonspecific immunity, specific immune suppression or deficiency disease, congenital bronchopulmonary dysplasia, vitamin or microelement deficiency, or is induced by some factors such as smoking, cross infection, and nursing errors.（2） Clinically, CRRI is commonly treated by anti-infective agents, symptomatic and supportive treatment, and immune-regulatory therapy. However, the therapeutic effectiveness is always imperfect, which could even lead to a premium on asthma, or nephritis, etc.

噬菌体治疗耐药菌肺部感染的研究进展

肺部感染因其高发病率和死亡率对社会造成重大影响,且随着耐药菌的层见叠出,传统抗生素的应用已不能满足临床治疗肺部感染的现状。噬菌体是细菌的天然寄生病毒,可以杀死细菌宿主,因其具有治疗肺部感染的潜力而备受关注。噬菌体治疗包括开发稳定的噬菌体制剂、进行临床前和临床研究,以评估疗效、药代动力学和安全性。本文基于近几年国内外有关噬菌体治疗的研究报道,从噬菌体制备储存、工程噬菌体、噬菌体临床前和临床研究、噬菌体治疗失败的潜在因素、提高噬菌体疗效的策略等方面进行阐述,并在最后指出了噬菌体治疗仍需解决的问题,旨在为未来噬菌体的抗菌研究及临床应用提供参考。

11例诺卡菌感染患者的临床特征分析

目的分析诺卡菌感染患者的临床特征,为诺卡菌病的诊治提供参考依据。方法回顾性收集并分析2018年9月至2023年7月在本院确诊为诺卡菌感染患者的临床资料。结果11例诺卡菌感染患者中,男性6例,女性5例;平均年龄(67.0±12.0)岁;平均住院天数(13.3±10.8)d。所有患者均伴有基础疾病,合并心脑血管疾病(72.7%)、慢性肺部疾病(45.5%)、低蛋白血症(45.5%)。11例诺卡菌感染患者出现发热(63.6%),咳嗽、咳痰(54.5%),胸闷、气促、胸痛、乏力(均为27.3%)等临床特征。胸部影像学检查可见斑片状密度影(72.7%),结节状、索条状密度影、胸腔积液(均为27.3%)等特征。实验室检查可发现白细胞计数(WBC)(45.5%)、中性粒细胞(N)比率(90.9%)及C-反应蛋白(CRP)、降钙素原(PCT)(均为63.6%)水平升高,清蛋白(ALB)水平(72.7%)降低。11例菌株,鉴定到诺卡菌属6例(54.5%),圣乔治诺卡菌3例(27.3%),豚鼠耳炎诺卡菌、新泻诺卡菌各1例(均为9.1%)。8例患者采用以甲氧苄啶-磺胺甲噁唑(TMP-SMZ)为基础,单独使用或联合用药;2例患者单独使用头孢哌酮/舒巴坦。治疗好转共9例(81.8%),放弃1例(9.1%),死亡1例(9.1%)。结论诺卡菌感染的临床表现缺乏特异性,容易误诊,及早开展病原学检测,有助于诺卡菌病的诊疗。TMP-SMZ可作为诺卡菌治疗的首选药物,单独或联合治疗,患者预后良好。

冠心病介入治疗后医院感染患者病原菌分布及耐药性

目的:分析冠心病介入治疗后医院感染患者病原菌分布及耐药性。方法:选取2020年5月至2023年5月该院收治的600例冠心病介入治疗患者进行前瞻性研究。统计冠心病介入治疗患者医院感染发生率,采集患者感染部位分泌物,并分析病原菌分布和耐药性。结果:600例冠心病介入治疗患者中,发生医院感染51例,医院感染发生率8.5%(51/600),感染部位包括呼吸道(41.18%)、泌尿系统(25.49%)、穿刺部位(13.73%)、胃肠道(11.76%)、皮肤组织(3.92%)等;51例发生医院感染患者感染部位分泌物中检出79株病原菌,包括革兰阳性杆菌41株(51.90%),其中金黄色葡萄球菌检出率最高(34.18%);革兰阴性杆菌38株(48.10%),其中大肠埃希菌检出率最高(29.11%);金黄色葡萄球菌对青霉素的耐药性为90%以上,对红霉素的耐药性为70%以上;大肠埃希菌对克林霉素的耐药性为100.00%,对红霉素的耐药性为80%以上,对青霉素的耐药性为70%以上。结论:金黄色葡萄球菌、大肠埃希菌为冠心病介入治疗后医院感染患者常见病原菌,其耐药性均较高。

苍苓散治疗婴幼儿轮状病毒肠炎临床研究

用苍苓散（治疗组）与腹可安（对照组）治疗婴幼儿轮状病毒肠炎１５０例，治疗组治愈率为６７．０７％，总有效率为９７．５６％，优于对照组（Ｐ＜０．０１），治疗组各症状改善时间均优于对照组（Ｐ＜０．０１），苍苓散对三种不同中医证候的轮状病毒肠炎疗效差异无显著性。连续检测用药三天后粪轮状病毒，治疗组测６５例转阴３１例，对照组测５４例转阴６例，两组比较差异有显著性（Ｐ＜０．０１）。

小儿轮状病毒肠炎100例不同药物治疗效果对比

目的:探讨两种不同药物在轮状病毒肠炎患儿中的治疗效果。方法:将100例轮状病毒肠炎患儿随机分为两组,每组50例,A组服用益生菌,B组服用免疫球蛋白。记录两组患儿治疗后每日的大便次数、性状、脱水情况等临床症状,对症状加重或出现脓血便者,行大便常规检测,查看是否出现继发性细菌性肠炎。收集治疗后第1、3、5、7、9天的新鲜大便,对肠道菌群失调分度进行判断,采用放射免疫疗法检测大便中SIgA含量及用酶联免疫法测量大便轮状病毒的排泄量。结果:1两组在治疗第3、5、7、9天的Ⅰ度失调、治疗第7、9天的Ⅱ度失调及治疗第3、5、7天的Ⅲ度失调均有显著性差异(P<0.05),A组小于B组;2两组在治疗第3、5、7天的继发性细菌感染上也有显著性义差异(P<0.05),其发生率A组明显低于B组;3两组在治疗第3、5、7、9天后SIgA含量也有显著性差异(P<0.05),B组含量高于A组;4两组在治疗后第3天的轮状病毒含量有显著性差异(P<0.05),B组低于A组;5两组在其他时间点的SIgA与轮状病毒含量无显著性差异(P>0.05);6两组治疗总有效率无显著性差异(P>0.05),但B组显效例数明显优于A组(P<0.05)。结论:益生菌能有效控制肠道细菌失调及预防继发性细菌感染,起效缓慢,而免疫球蛋白起效快,能快速促进机体SIgA的生成及促进轮状病毒的清除,但两者疗效相当。

云南省临沧地区2009-2014年HIV-1基因型耐药情况分析

目的了解2009-2014年云南省临沧地区人类免疫缺陷病毒(HIV)-1的耐药发生情况及特点。方法收集云南省临沧地区2009-2014年接受免费高效抗逆转录病毒治疗(HAART)的HIV感染/艾滋病(AIDS)患者的临床及实验室资料,对抗病毒治疗持续6个月以上、病毒载量≥1000拷贝/mL的患者进行基因型耐药检测,分析耐药突变位点及耐药发生情况。结果2009-2014年云南省临沧地区接受免费HAART的患者共13491例,其中1935例患者发生抗病毒治疗病毒学失败,抗病毒治疗病毒学失败的患者中发生基因型突变894例,占病毒学失败患者的46.2%(894/1935),占抗病毒治疗总人群的6.6%(894/13491)。耐药突变位点主要为M184V/I(23.2%)、K103N/S(19.5%)、Y181C/V(8.1%)、G190A/S(7.9%)和V179D/E(7.9%)。抗病毒药物中,对奈韦拉平、依非韦仑高度耐药的构成比分别为34.5%(668/1935)、27.1%(524/1935);对拉米夫定、齐多夫定、司他夫定、替诺福韦高度耐药的构成比分别为23.5%(455/1935)、3.5%(68/1935)、3.5%(68/1935)、1.6%(31/1935);对洛匹那韦/利托那韦高度耐药的构成比为0.8%(15/1935)。随着治疗时间延长,耐药突变有上升的趋势。结论当前云南省临沧地区AIDS抗病毒治疗失败患者中耐药突变状况的复杂多样,是导致抗病毒治疗失败的主要原因,抗病毒治疗过程中加强依从性教育并及时做好耐药监测工作,是提高疗效的关键。