红河州HAART的HIV／AIDS病人的耐药性及其影响因素

目的了解红河州接受高效抗反转录病毒治疗（HAART）后,艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）体内HIV基因耐药性及其影响因素。方法选择2005-2011年入组的、抗病毒治疗超过1年的在治病人3371例,于2010-2012年间检测血浆HIV病毒载量,对病毒载量〉1000拷贝/mL的样本进行聚合酶链反应（PCR）和扩增测序,使用斯坦福大学HIV耐药数据库对比得到基因耐药结果。结果治疗1年以上的3371例病人做过血浆HIV病毒载量检测,HIV毒株总耐药率为4.5%（152/3371）,对核苷类反转酶抑制剂（NRTIs）的耐药率为3.1%（105/3371）、对非核苷类反转录酶抑制剂（NNRTIs）的耐药率为3.7%（121/3291）、对蛋白酶抑制剂（PIs）的耐药率2.5%（2/80）,对NRTIs、NNRTIs的耐药程度明显高于PIs类（χ^2=94.791,P〈0.05）。最为常见的耐药基因位点有M184V、D67N、T215Y、K219R、K70R、K103N、Y181C、G190A、K101P。经静脉吸毒感染者,HIV的耐药发生率高于性接触途径感染者（χ^2=10.898,P〈0.005）。在多因素Logistic回归模型分析中,近期吸毒、无固定性伴、不规范服药与耐药的发生呈负相关。结论云南省红河州进行HAART治疗的HIV/AIDS病人中,HIV毒株耐药率处于较低水平,对PIs耐药率极低,PIs仍可作为非核苷类药物耐药后的替代药品。应加强吸毒、无配偶或无固定性伴病人的随访,提高服药依从性,及时检测血浆病毒载量,有利于降低耐药的发生。

Drug resistance and its influence factors in AIDS patients receiving HAART in Honghe Prefecture

Objective To explore drug resistance and its influence factors in AIDS patients receiving highly active antiretroviral therapy（HAART）in Honghe Prefecture,Yunnan Province.Methods Our study enrolled 3371 AIDS patients taking HAART for at least one year initiated from 2005 to 2011.Viral loads were detected continuously from 2010 to 2012,and samples were amplified and sequenced when viral loads exceeded 1000copies/ml.Then,results of genetic resistance were achieved by comparing our data with the HIV drug resistance database of Stanford University.Results There were 3371 patients who were treated for more than 1year and got viral load detection.Total drug resistance rate was 4.5%（152/3371）.Resistant rate to NRTIs,NNRITs and PIs was 3.1%（105/3371）,3.7%（121/3291）and 2.5%（2/80）,respectively,which was significantly lower than that to NRTIs and NNRTIs（χ^2=94.791,P0.05）.The most common drug resistance gene loci were M184 V,D67N,T215 Y,K219R,K70 R,K103N,Y181 C,G190Aand K101 P.Resistance of HIV infected via intravenous drug use was higher than that via sex behavior（χ^2=10.898,P0.005）.In a multi-factors logistic regression model analysis,recent drug use,no fixed sexual partner and non-standard medication had negative correlation with resistance.ConclusionHIV strains have a low level of resistance in HAART treated HIV/AIDS patients in Honghe Prefecture,Yunnan.The PI-resistant rate is extremely low.PIs can be used as alternative medications when NNRTIs are resistant.We should strengthen follow-up in HIV/AIDS patients of drug use and/or without fixed sex partners,and improve drug adherence and viral load detection to reduce the occurrence of drug resistance.