浙江省三个城市274例HAART病人耐药性及其影响因素

目的了解浙江省杭州、宁波、温州三个市艾滋病病毒(HIV)感染者/艾滋病(AIDS)(简称HIV/AIDS病人)高效抗反转录病毒治疗(HAART)后,HIV-1基因耐药性的影响因素。方法在三个治疗病人数最多的市,采用问卷调查和血液采集,检测病人病毒载量,对病毒载量大于1 000IU/mL的样本,进行反转录-聚合酶链反应(RT-PCR)和扩增测序(In-house)法扩增测序,使用斯坦福大学HIV耐药数据库对比得到基因耐药结果。结果共274例研究对象纳入研究分析,HIV-1毒株总耐药率为7.7%。治疗时间1-3年的耐药率差异无统计学意义(χ2=0.554,P=0.456),治疗4-5年后,耐药率差异有统计学意义(P=0.004,P=0.028)。HIV-1毒株对核苷类(NRTI)和非核苷类(NNRTI)抗病毒治疗药物的耐药程度,明显高于蛋白酶抑制剂(PI)(χ2=29.672,P<0.001),核苷类反转录酶抑制剂与非核苷类相比,耐药程度无统计学差异(χ2=2.875,P=0.593)。在多因素Logistic回归模型分析中,吸毒、无固定性伴、治疗方案D4T+3TC+NVP和治疗方案AZT+3TC+NVP与耐药发生的关联具有统计学意义。结论浙江省进行HAART的AIDS病人,其体内毒株已经出现耐药现象,但耐药率处于较低水平。应加强对吸毒人群和无配偶或无固定性伴人群的随访,提高服药依从性,对各相关的治疗方案要加强监测,有利于降低耐药的发生。

Drug resistance in 247 HIV /AIDS cases receiving HAART in Zhejiang province and related risk facotrs

Objective To investigate risk factors related to genotype drug resistance in HIV/AIDS patients receiving HAART in Zhejiang province.Methods HIV/AIDS cases who were older than 18 years in Hangzhou,Ningbo and Wenzhou cities were selected to participate in the study.Questionnaires were administered among the selected cases and their blood specimens were taken to test the viral load.RT-PCR and In-house technique were used to detect the genotype drug resistance in the blood specimens which viral load was larger ...