湖南省52例艾滋病抗病毒治疗失败及耐药病例分析

目的了解湖南省艾滋病抗病毒治疗失败病例耐药情况,分析其特点和影响因素。方法对治疗时间在6个月以上,且病毒载量检测〉1 000拷贝/ml的52例病人进行耐药检测,将耐药结果结合病人的随访和检测数据进行分析,探讨病例耐药特点和可能的影响因素。结果 52例病人中,27例存在低度以上的耐药,25例未发现耐药,核苷类和非核苷类耐药最为常见,对蛋白酶类药品未发现耐药。耐药个案的治疗方案中,D4T＋3TC＋NVP最常见,占51.9%,其次是AZT＋3TC＋NVP方案,占25.9%。治疗时间在12~24个月的所占比例最大,占37%,其次是36个月以上的,占29.6%。耐药病例与非耐药病例的分组检验提示耐药组与非耐药组抗病毒治疗时间差异有统计学意义,与非耐药组相比,耐药组治疗时间较长。结论治疗失败可能的原因主要是依从性不良和耐药,目前一线治疗方案中的药物都有不同程度的耐药出现,加强依从性教育、早期开展治疗可减少或延缓治疗失败和继发性耐药的发生。

Analysis of 52 Failure Cases with HAART and Their Drug Resistance in Hunan Province

Objective To investigate the drug resistance of failure cases with highly active anti-retroviral therapy(HAART) in Hunan Province,and to analyze the characteristics and the influencing factors of HAART treatment failure.Methods We conducted drug resistance test for those 52 cases whose time of therapy was over six months and viral load was over 1,000 copies/ml.And then we analyzed the drug resistance results combined with the follow-up information,moreover,the drug resistance characteristics and the possible influencing factors were discussed.Results Among 52 cases,the drug resistance was found in 27 ones.As for the resistance cases,resistance for NRTIs and NNRTIs was the most common and PIs were still sensitive till then.As for the regimen of resistant cases,D4T+3TC+NVP took a large proportion(51.9%),followed by AZT+3TC+NVP(25.9%).As for the time of therapy,37% of the cases were over 12~24 months and 29.6% were over 36 months.Group T-test of resistance and non-resistance cases indicated that baseline CD4 count and time of therapy were different with statistical significance.Conclusions Possible reasons of treating failure are poor adherence and drug resistance.Different levels of drug resistance have occurred in the first-line regimens.Strengthening adherence education and beginning ART in early stage can reduce or slow down the occurrence of treating failure and drug resistance.