山东省部分艾滋病患者抗病毒治疗效果及耐药性研究

目的了解山东省艾滋病患者高效抗逆转录病毒治疗（HAART）效果和病例中HIV-1耐药毒株的出现情况及其对治疗产生的影响。方法于2004、2005年分别对治疗和未接受抗病毒治疗的HIV感染人群进行2次横断面调查。对接受调查者经知情同意，进行个人访谈填写耐药性研究调查表并进行免疫学、病毒学实验室指标评价和服药依从性调查；测定CD4^＋T淋巴细胞计数、血浆病毒载量（VL）；用RT-PCR方法扩增HIV-POL区基因，进行基因型耐药性分析。结果正在接受治疗的艾滋病患者31例，未治疗的27例，2年内分别有83．3％、64．5％的治疗患者CD4^＋T淋巴细胞计数〉350个／μl，分别有45．8％、45．2％的治疗患者VL达到检测限以下，与未治疗组的差异有统计学意义。治疗组患者中出现7个耐药位点，未治疗组出现4个耐药位点，高度耐药突变率及总耐药性突变率前者远高于后者。结论抗病毒治疗患者大部分达到了病毒抑制和免疫重建的目的，症状得到明显好转，治疗患者中出现HIV耐药性毒株，但对总体治疗效果影响不大。

Study on the effect of treatment and the status of drug resistance among HIV/AIDS patients treated with highly active antiretroviral therapy in Shandong province

OBJECTIVE: To understand the effect of highly active antiretroviral therapy (HAART) on AIDS patients, and to explore the prevalence and the impact of HIV-1 drug resistance in Shandong province. METHODS: 2 cross-sectional studies were carried on in 2004 and 2005, to collect data on clinical symptoms and compliance of the AIDS patients with HAART through questionnaire. Informed-consent principle was followed to test on immunological, viral and laboratory index of them. HIV-1 drug genotype resistance by sequencing the gene of HIV-POL after RT-PCR was performed and analyzed. RESULTS: 31 AIDS cases with and. 27 AIDS cases without HAART, were studied. 83.3% and 64.5% of the AIDS patients with HAART showed that the CD4+ T cell count was rising to over 350/microl, in the first study (2004) and in the second (2005) study respectively but still 45.8% and 45.2% of AIDS patients under HAART in the 2 years showed a decreasing HIV load under the detected limit. However, these findings were showing remarkable difference when compared with the AIDS without HAART. 7 drug resistance gene sites were found in AIDS patients with HAART and in AIDS patients without HAART. The rate on high degree drug resistance mutation and total drug resistance rate of mutation of the former were higher remarkably than those of the latter. CONCLUSION: Most of the AIDS patients with HAART met the purpose of rebuilding immunity and control of HIV,as well as alleviation of symptoms. Although the drug resistance stain appeared in Shandong,but had little effect on HAART. AIDS; Drug resistance; Highly active antiretroviral therapy