四川省越西县和昭觉县HIV抗病毒治疗停药患者耐药调查

目的了解四川凉山州HIV抗病毒治疗停药患者的耐药情况。方法在四川省凉山州选择抗病毒治疗人数较多的越西县和昭觉县两个治疗点,对其2018年HIV抗病毒治疗停药患者按照抗病毒治疗号顺序进行横断面调查,收集调查对象社会人口学、高危行为以及抗病毒治疗情况等数据;采集全血分离血浆检测病毒载量,提取核酸和pol基因区扩增测序进行耐药检测。结果调查273例患者,54.7%(140/273)患者的病毒载量≥1000拷贝/mL;成功获得206份序列进行耐药分析,16.0%(33/206)患者检出耐药。病毒载量≥1000拷贝/mL的比例随着停药时间的延长而增大,而耐药的比例随着停药时间的延长而减小。昭觉县的耐药率高于越西县(aOR=2.97,95%CI=1.17~7.54,P=0.022);未婚的患者耐药率比在婚或同居的患者高(aOR=2.58,95%CI=1.27~7.40,P=0.042)。停药时间>24个月患者的耐药率比停药时间1~<24个月低(aOR=0.32,95%CI=0.14~0.76,P=0.001)。近一年内发生无保护性行为的比例为72.2%。结论HIV抗病毒治疗停药患者耐药和无保护性行为比例均高,需对该人群加强宣传教育,减少HIV毒株尤其是耐药株的传播。

Drug resistance in HIV/AIDS patients who stopped ART in Yuexi and Zhaojue of Liangshan,Sichuan

Objective To investigate the prevalence of drug resistance in HIV/AIDS patients who had stopped antiretroviral therapy in Liangshan, 2018. Methods A cross-sectional survey was conducted among the HIV/AIDS patients who had stopped antiretroviral therapy in Yuexi and Zhaojue of Liangshan, 2018.Data on social demography, high-risk behaviors and antiviral treatment were collected.The blood samples were collected and HIV-1 viral load was detected. The samples and polgene were amplified and sequenced for drug resistance testing. Results Of the 273 HIV/AIDS patients who had stopped ART, 140(54.7%) cases viral loads were higher than 1 000 copies/mL. Among 206 samples which were successfully amplified and sequenced, 33(16.0%) individuals showed resistance to NRTIs, NNRTIs and PIs. With the increase of stopping time, the proportion of viral load ≥1 000 copies/mL increased,and the drug resistance rate decreased, separately. The drug resistance rate of Zhaojue county was higher than that of Yuexi county (aOR = 2.97,95%CI=1.17- 7.54, P= 0.022). The drug resistance rate of unmarried patients was higher than that of married or cohabiting patients (aOR=2.58,95%CI=1.27-7.41, P=0.042). The drug resistance rate of patients stopped ART >24 months was lower than that of 1-<24 months (aOR=0.32, 95%CI=0.14-0.76, P=0.001). The proportion of high risk sexual behavior in the last year was 72.2%. Conclusion HIV/AIDS patients who had stopped antiretroviral therapy in our research have high drug resistance rate and high risk sexual behavior proportion. We suggest that the management and interventions of those people should be strengthen to control the transmission of HIV, especially HIV resistant strain.