云南省≥50岁抗病毒治疗失败的HIV/AIDS患者基因型耐药分析

目的 分析云南省≥50岁艾滋病病毒(HIV)感染者/艾滋病(AIDS)患者(HIV/AIDS患者)抗病毒治疗失败的基因型耐药情况。方法 收集2017年1月1日-2018年12月31日年龄≥50岁且抗病毒治疗时间≥6个月的HIV/AIDS患者检测病毒载量≥1 000 copies/mL的血浆标本,对该样本进行基因型耐药检测。结果 通过基因型耐药检测共获得符合条件pol区序列260条,该人群中耐药发生率为63.1%(164/260)。三类抗病毒药物在使用中,耐药率较高的药物分别是奈韦拉平(NVP)、依非韦伦(EFV)和拉米夫定(3TC),耐药率分别为51.2%(133/260)、50.8%(132/260)、32.3%(84/260),PIs类则较低;耐药率较低的药物分别是替诺福韦(TDF)、齐多夫定(AZT)和克力芝(LPV/r),耐药率分别为11.5%(30/260)、6.2%(16/260)、1.2%(3/260)。耐药突变位点主要有M184、K103、G190和V179,突变率分别为30.8%(80/260)、28.5%(74/260)、14.6%(39/260)和13.1%(34/260)。结论 云南省≥50岁抗病毒治疗失败患者的耐药率相对较高,应加强老年艾滋病患者的管理,对治疗失败的患者,应根据耐药检测结果及时调整抗病毒治疗方案。

HIV/AIDS genotype resistance in patients≥50 years old who failed antiviral therapy in Yunnan

Objective Analysis of genotype resistance of antiviral treatment failure in HIV/AIDS patients aged≥50 years in Yunnan Province. Methods Plasma samples with viral load≥1 000 copies/mL were tested on January 1,2017-December 31, 2018, and aged≥50 with antivirus treatment time≥6 months were tested for genotype resistance. Results A total of 260 qualified pol sequences were obtained by genotype resistance test,and the incidence of drug resistance in this population was 63.1% (164/260).Among the used drugs,the drugs with higher resistance rates were nevirapine (NVP),efavirenz (EFV) and lamivudine (3TC), with drug resistance rates of 51.2% (133/260), 50.8% (132/260) and 32.3% (84/260), respectively. The drugs with lower drug resistance rates were tenofovir (TDF),zidovudine (AZT) and lopinavir/ritonavir (LPV/r), with drug resistance rates of 11.5%(30/260), 6.2% (16/260) and 1.2% (3/260), respectively. Resistance mutation siteswere mainly M184, K103, G190 and V179, with mutation rates of 30.8%(80/260),28.5% (74/260), 14.6%(39/260) and 13.1% (34/260),respectively. Conclusion The drug resistance rate of patients≥50 years old with failed antiviral treatment in Yunnan Province is relatively high,so the management of elderly AIDS patients should be strengthened. For patients who have failed treatment, the antiviral treatment regimen should be adjusted timely according to the results of resistance test.