广西崇左市4个边境市县抗病毒治疗HIV感染者耐药情况及基因型

目的 了解广西崇左市4个边境市县（大新县、宁明县、凭祥市、龙州县）接受抗病毒治疗的艾滋病病毒（HIV）感染者的基因型耐药情况及其影响因素,为该地区艾滋病治疗人群的抗病毒治疗（ART）方案调整和优化提供科学依据。方法 纳入2018年1月—2018年9月371例来自崇左市4个边境市县年龄≥18岁的HIV感染者,收集研究对象抗病毒治疗信息和pol区基因序列进行基因亚型和耐药情况分析。结果 获得371例患者的HIV pol区序列,对抗病毒药物产生耐药有62例,总体耐药率16.7%,耐药患者基因亚型以CRF01_AE为主,占72.6%,其次是CRF08_BC,占22.6%;耐药类型以非核苷类药物为主,占75.8%,耐药突变位点以K103N为主,主要对EFV和NVP产生耐药。多因素Logistic回归分析结果显示,地区来源于龙州县（OR=3.392,95%CI：1.093~10.525）、基因亚型为08BC(OR=9.431,95%CI：3.296~26.985),更换过治疗方案（OR=2.662,95%CI：1.241~5.708）与检出基因型耐药密切相关。基因距离分析显示CRF01_AE>CRF08_BC>CRF07_BC;不同亚型中,耐药组基因距离均大于非耐药组。结论 广西边境部分地区HIV/AIDS 患者抗病毒治疗耐药率较高,且高度耐药占比较高,需加强合理用药、HIV耐药检测,提高患者服药依从性。

Drug resistance and genotypes of HIV-infected patients with antiviral therapy in 4 border cities and counties in Chongzuo,Guangxi

Objective To determine the prevalence of HIV-1 genotypes and related factors among human immunodeficiency virus (HIV) infectors and acquired immune deficiency syndrome (AIDS) patients receiving anti-retrovirus therapy (ART) in Chongzuo, a border city of Guangxi, we performed the drug resistance analysis to provid scientific basis for optimizing the antiviral treatment schemes of those patients. Methods The pol gene sequences and information of antiviral treatment of 371 patients who received the national free antiretroviral therapy in Daxin, Ningming, Pingxiang and Longzhou counties from January 2018 to September 2018 were enrolled. The obtained sequences were submitted to Stanford HIV drug resistance database for subtypes and drug resistance analysis. Results There were 62 patients (16.7%) with drug resistance were identified among the 371 patients, of which CRF01_AE (72.6%) and CRF08_BC (22.6%) were the dominant subtypes. Drug resistance mostly occurred in NNRTIs (75.8%), especially EFV and NVP, of which K103N was the dominant mutation site. Results of Logistic regression analysis showed that patients from Longzhou (OR=3.392, 95%CI:1.093-10.525), infected with CRF_08BC subtype (OR=9.431, 95%CI:3.296-26.985), changed the therapy (OR=2.662, 95%CI:1.241-5.708) were close related to the occurrence of drug resistance. Genetic distance analysis showed that CRF01_AE>CRF08_BC>CRF07_BC; in different subtypes, the genetic distance of drug-resistant group was greater than that of non-drug-resistant group. Conclusion HIV/AIDS patients with ART have a severe prevalence of drug resistance mutations in Guangxi border area. Therefore, rational use of drugs and HIV-1 resistance surveillance should be enhanced, and medication compliance should be improved.