傅卓华, 黄志征, 赵秀萍, 雅雪蓉, 赵艳秋. 苏州市艾滋病抗病毒治疗病毒学效果及耐药研究[J]. 上海预防医学, 2019, 31(12): 968-972. DOI: 10.19428/j.cnki.sjpm.2019.19776
引用本文: 傅卓华, 黄志征, 赵秀萍, 雅雪蓉, 赵艳秋. 苏州市艾滋病抗病毒治疗病毒学效果及耐药研究[J]. 上海预防医学, 2019, 31(12): 968-972. DOI: 10.19428/j.cnki.sjpm.2019.19776
FU Zhuo-hua, HUANG Zhi-zheng, ZHAO Xiu-ping, YA Xue-rong, ZHAO Yan-qiu. Virologic effect and drug resistance study on antiviral therapy for AIDS in Suzhou City[J]. Shanghai Journal of Preventive Medicine, 2019, 31(12): 968-972. DOI: 10.19428/j.cnki.sjpm.2019.19776
Citation: FU Zhuo-hua, HUANG Zhi-zheng, ZHAO Xiu-ping, YA Xue-rong, ZHAO Yan-qiu. Virologic effect and drug resistance study on antiviral therapy for AIDS in Suzhou City[J]. Shanghai Journal of Preventive Medicine, 2019, 31(12): 968-972. DOI: 10.19428/j.cnki.sjpm.2019.19776

苏州市艾滋病抗病毒治疗病毒学效果及耐药研究

Virologic effect and drug resistance study on antiviral therapy for AIDS in Suzhou City

  • 摘要:
    目的了解苏州市艾滋病抗病毒治疗病毒抑制和耐药位点突变情况。
    方法对2005年3月1日-2018年12月31日期间入组进行艾滋病抗病毒治疗、治疗时间≥ 6个月、年龄≥ 16岁者进行血浆HIV病毒载量(VL)及基因型耐药突变位点检测。
    结果共2 881人纳入研究,2 541人(88.2%)VL持续≤ 1 000 copies/mL,340人(11.8%)曾检出VL>1 000 copies/mL;最近1次VL检测中2 728人(94.7%)≤ 1 000 copies/mL,153人(5.3%)>1 000 copies/mL,病毒学失败率为5.3%。离异或丧偶、基线CD4 ≤ 200个/mm3、治疗时间 < 1年或≥ 1年且 < 3年、初始治疗方案为AZT(齐多夫定)+3TC(拉米夫定)+EFV(依非韦伦)或AZT+3TC+NVP(奈韦拉平)者病毒学失败率高,差异有统计学意义(P < 0.05)。340名VL>1 000 copies/mL者中,278人(81.8%)成功扩增样本,其中135人(48.6%)检出耐药突变位点,以核苷类和非核苷类反转录酶抑制剂类耐药为主,突变频率最高位点分别为M184V/I和K103N/Q。年龄36~45岁、基线CD4计数≤ 200个/mm3、CRF01_AE亚型者耐药发生比例高,分别为53.3%、67.9%、55.4%。
    结论苏州市艾滋病抗病毒治疗病毒抑制率较高,但病毒学失败者中耐药突变位点检出率高。应针对重点人群开展早期治疗和依从性教育,定期开展VL和耐药监测,最大限度地发挥抗病毒治疗的作用。

     

    Abstract:
    ObjectiveTo investigate the status of HIV antiviral suppression and drug resistance mutations in HIV/AIDS patients receiving antiretroviral therapy(ART) in Suzhou City.
    MethodsHIV/AIDS patients, who were enrolled from March 1, 2005 to Dec 31, 2018 for treatment at age of 16 years or above and with ART duration of 6 months or above, were detected with venous blood for HIV viral load(VL) and genotype resistance mutation site.
    ResultsA total of 2 881 patients were included for the study, of whom 2 541(88.2%) kept VL ≤ 1 000 copies/mL; 340(11.8%) were detected with VL>1 000 copies/mL; and in the latest VL detection, 2 728 patients(94.7%) ≤ 1 000 copies/mL and 153(5.3%)>1 000 copies/mL; viral failure was 5.3%.The divorced and widowed, those with base line CD4 ≤ 200 cells/mm3, duration of treatment < 1 year or ≥ 1 year but < 3 years, and those with initial treatment plan as AZT+3TC+EFV or AZT+3TC+NVP were the highest in viral failure rate, and the differences had statistical significance(P < 0.05).Of 340 with VL>1 000 copies/mL, 278 (81.8%) successfully amplified samples.Among them, 135 patients(48.6%) were detected with drug resistace mutation sites, nucleoside and non-nucleoside reverse transcriptase inhibitors being mainly resistant to drugs, and the highest mutation frequency sites being M184/I and K103N/Q, respectively.Those aged 36-45, with baseline CD4 count ≤ 200 cells/mm3 and CRF01_AE subtype had higher incidence of drug resistace, which were 53.3%, 67.9% and 55.4%, respectively.
    ConclusionSuzhou City has made remarkable progress toward the viral suppression among HIV/AIDS.However, with viral losers the detection rates of drug resistacne mutation sites are high.With key population, early treatment and compliance education should be developed.VL and drug resistance monitoring should be carried out, so as to maximize the role of antiviral therapy.

     

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