河南某农村艾滋病患者劣势耐药毒株的进化及原发耐药研究

目的 了解河南省部分艾滋病患者抗病毒治疗效果及耐药发生情况,分析劣势耐药毒株在该人群本底存在情况.方法 以河南某农村149名初始接受抗病毒治疗的艾滋病患者为研究埘象,采用自建(In-house)基因型耐药检测方法分析抗病毒治疗失败患者HIV-1耐药发生情况,对抗病毒治疗后产生耐药的病例采用等位基因特异性实时定量PCR(allele-specific real-time PCR,ASPCR)方法检测其抗病毒治疗前样本劣势耐药毒株存在情况.结果 抗病毒治疗后患者的HIV-1病毒载量显著下降(t=275,P＝0.0001),但CD4+T淋巴细胞绝对数无明显变化(t＝1.765 168,P=0.0852).抗病毒治疗失败患者中耐药的发生率为4.88%,ASPCR检测发现,在调查基线时,7例耐药患者伞部存在劣势M184V突变,5例存在劣势K103N突变.结论 河南省部分未治疗的艾滋病患者存在HIV-1原发性耐药毒株,劣势耐药突变可能发展为优势耐药毒株并影响抗病毒治疗的效果.

Abstract：

Objective To evaluate the antiretroviral therapy(ART),analyze the prevalence of resistance in rural areas,Henan,and explore the presence of minor resistant variants in pre-ART.Methods One hundred and forty-nine AIDS patients initiating ART were recruited and investigated at intervals of 6 months. Method of In-house developed by our laboratory for genotypjc resistance test was to analyze the occurrence of resistance among the failure of ART,and the allele-specific real.time PCR(ASPCR)was used to detect the minor resistant variants at the baseline samples once the resistance occurred.Results Vimlload significantly decreased among the patients who received ART(t=275,P=0.0001),but the absolute counts of CD4+T lymphocytes had no significant change(t=1.765 168,P=0.0852).Rate of resistance among the patients of treatment failure was 4.88%.The result of ASPCR in the survey of baseline showed that the minor resistant variants of M184V were detected in 7 patients and mutation K103N presented in 5 patients.Conclusion The primary drug-resistant straias in the untreated patients were found in Henan,and they might develop the dominant resistance strains and bring about the failure of ART.

Study on the evolution of the minor resistant mutations and the primary resistance in rural areas of Henan

Objective To evaluate the antiretroviral therapy(ART),analyze the prevalence of resistance in rural areas,Henan,and explore the presence of minor resistant variants in pre-ART.Methods One hundred and forty-nine AIDS patients initiating ART were recruited and investigated at intervals of 6 months. Method of In-house developed by our laboratory for genotypjc resistance test was to analyze the occurrence of resistance among the failure of ART,and the allele-specific real.time PCR(ASPCR)was used to detect the minor resistant variants at the baseline samples once the resistance occurred.Results Vimlload significantly decreased among the patients who received ART(t=275,P=0.0001),but the absolute counts of CD4+T lymphocytes had no significant change(t=1.765 168,P=0.0852).Rate of resistance among the patients of treatment failure was 4.88%.The result of ASPCR in the survey of baseline showed that the minor resistant variants of M184V were detected in 7 patients and mutation K103N presented in 5 patients.Conclusion The primary drug-resistant straias in the untreated patients were found in Henan,and they might develop the dominant resistance strains and bring about the failure of ART.