自贡市HIV抗病毒治疗效果及耐药情况分析
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摘要
目的分析2016年自贡市HIV抗病毒治疗效果及耐药情况。方法选取2016年自贡市接受HIV抗病毒治疗6个月以上病例1 258例,进行病毒载量检测,对病毒载量>1 000 cps/ml的样本进行耐药检测分析。结果 1 258例患者中,病毒载量>1 000 cps/ml有89例,病毒抑制失败率7.07%(89/1 258);病毒载量<400 cps/ml有1 144例,抗病毒治疗有效率90.94%(1 144/1 258);除去5例既往病例,有39例出现不同程度的耐药,耐药率3.10%(39/1 258),病毒抑制失败耐药率46.43%(39/84);39例耐药样本中,38例(97.43%)对非核苷类反转录酶抑制剂(NNRTIs)耐药,30例(76.92%)对核苷类反转录酶抑制剂(NRTIs)耐药,2(5.13%)例对蛋白酶抑制剂(PIs)耐药;耐药毒株对NRTIs主要突变位点为M184V/I/MV、K65R/KR,对NNRTIs主要突变位点主要为K103KN/N、Y181C/CY/YF、G190A/S/C/GA、V179T/E/VD/D,对PIs主要突变位点为V82A,次要突变位点主要为K20R、Q58E;耐药突变毒株,以CRF01_AE亚型和CRF07_BC亚型为主。结论自贡市2016年HIV抗病毒治疗效果较好,病毒抑制失败率和耐药率相对较低,但对NNRTIs耐药程度高,交叉耐药占比也较高,还出现1例对3类药物耐药病例。随着抗病毒治疗病人的不断增加,应重视耐药性监测工作,并及时评估治疗效果及耐药情况,同时应提高患者依从性教育,减少耐药株的产生和传播。
Objective To analyze the HIV antiviral treatment effect and drug resistance of HIV/AIDS patients in Zigong in 2016. Methods In 2016,1 258 cases who had received HIV antiviral treatment for more than 6 months in Zigong city were selected for viral load test. Drug resistance analysis was performed on samples with viral load >1 000 cps/ml. Results Among the 1 258 patients,there were 89 patients with viral load >1 000 cps/ml, and the failure rate of virus suppression was7.07%(89/1 258). There were 1 144 cases with viral load<400 cps/ml, and the effective rate of antiviral therapy was 90.94%(1 144/1 258).Five cases with viral load >1 000 cps/ml were excluded due to negative amplification. There were 39 cases with varying degrees of drug resistance, and the drug resistance rate was3.10%(39/1 258). The drug resistance rate of samples with virus suppression failure was 46.43%(39/84). Among the 39 drug resistant samples,38(97.43%) were resistant to non-nucleoside reverse transcriptase inhibitors(NNRTIs),30(76.92%)were resistant to nucleoside reverse transcriptase inhibitors(NRTIs),and 2(5.13%) were resistant to protease inhibitors(PIs). M184 V/I/MV and K65 R/KR were the main mutation sites of the drugresistant strain for NRTIs. The main mutation sites for NNRTIs were K103 KN/N, Y181 C/CY/YF,G190 A/S/C/GA and V179 T/E/VD/D. For PIs, the main mutation site was V82 A, the secondary mutation sites were K20 R and Q58 E. Drug-resistant mutant strains were mainly CRF01_AE subtype and CRF07_BC subtype. Conclusion In 2016, the antiviral effect of HIV-1 in Zigong was generally good,the failure rate and drug resistance rate of viral inhibition were relatively low,but the degree of resistance to NNRTIs was high, and the proportion of cross-resistance was also high. Notably, there was one case of drug resistance to three types of drugs. With the increasing number of patients receiving antiviral therapy, more attention should be paid to drug resistance monitoring, the treatment effect and drug resistance should be evaluated in time. Meanwhile, the compliance education of patients should be improved to reduce the generation and spread of drugresistant strains.
Objective To analyze the HIV antiviral treatment effect and drug resistance of HIV/AIDS patients in Zigong in 2016. Methods In 2016,1 258 cases who had received HIV antiviral treatment for more than 6 months in Zigong city were selected for viral load test. Drug resistance analysis was performed on samples with viral load >1 000 cps/ml. Results Among the 1 258 patients,there were 89 patients with viral load >1 000 cps/ml, and the failure rate of virus suppression was7.07%(89/1 258). There were 1 144 cases with viral load<400 cps/ml, and the effective rate of antiviral therapy was 90.94%(1 144/1 258).Five cases with viral load >1 000 cps/ml were excluded due to negative amplification. There were 39 cases with varying degrees of drug resistance, and the drug resistance rate was3.10%(39/1 258). The drug resistance rate of samples with virus suppression failure was 46.43%(39/84). Among the 39 drug resistant samples,38(97.43%) were resistant to non-nucleoside reverse transcriptase inhibitors(NNRTIs),30(76.92%)were resistant to nucleoside reverse transcriptase inhibitors(NRTIs),and 2(5.13%) were resistant to protease inhibitors(PIs). M184 V/I/MV and K65 R/KR were the main mutation sites of the drugresistant strain for NRTIs. The main mutation sites for NNRTIs were K103 KN/N, Y181 C/CY/YF,G190 A/S/C/GA and V179 T/E/VD/D. For PIs, the main mutation site was V82 A, the secondary mutation sites were K20 R and Q58 E. Drug-resistant mutant strains were mainly CRF01_AE subtype and CRF07_BC subtype. Conclusion In 2016, the antiviral effect of HIV-1 in Zigong was generally good,the failure rate and drug resistance rate of viral inhibition were relatively low,but the degree of resistance to NNRTIs was high, and the proportion of cross-resistance was also high. Notably, there was one case of drug resistance to three types of drugs. With the increasing number of patients receiving antiviral therapy, more attention should be paid to drug resistance monitoring, the treatment effect and drug resistance should be evaluated in time. Meanwhile, the compliance education of patients should be improved to reduce the generation and spread of drugresistant strains.
引文
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[10]吴少慧,卢春明,姜凤霞,等.辽宁省艾滋病治疗患者耐药基因特征及分子流行病学分析[J].中华预防医学杂志,2011,45(7):619-624.
[11]颜苹苹,谢美榕,吴守丽,等.福建省艾滋病患者抗病毒治疗和耐药检测分析[J].中国人兽共患病学报,2008,24(10):896-900.
[12]Medeiros MS,Arruda EA,Guerrant RL,et al. Impact of the number of failed therapeutic regimes on the development of resistance mutations to HIV-1 in Northeast Brazil[J]. Braz J Infect Dis,2007,11(5):451-455.
[13]Johnsin H,Van Craenenbroeck E, Alan P, et al.Prediction of HIV-1drug susceptibility phenotype from the viral genotype using linear regressing modeling[J]. J Virol Methods,2007,145:47-55.
[2]李虹,陈媛媛,何云,等.两种HAART方案对HIV/AIDS患者血脂的影响[J].重庆医学,2014,43(20):2574-2576.
[3]Organon Tekinika公司.NASBA NucliSens System操作手册[M].荷兰:Organon Tekinika公司,2001:.
[4]中国疾病预防控制中心.HIV耐药监测策略和检测技术[M].北京:人民卫生出版社,2010:116-128.
[5]全国艾滋病检测技术规范编写组.全国艾滋病检测技术规范[M].2015年修订版.北京:中国疾控中心,2015:30-30.
[6]袁丹,叶黎,苏玲,等.四川省2011年HIV-1抗病毒治疗患者耐药情况及亚型分析[J].现代预防医学,2013,40(22):4248-4251.
[7]罗德维,王顺东,王卓,等.四川省达州HIV-1感染者抗病毒治疗耐药性及耐药亚型分析[J].预防医学情报杂志,2016,32(1):39-45.
[8]吴薇,袁丹,李娜,等.2015年乐山市HIV-1抗体阳性病例抗病毒治疗效果及耐药分析[J].江苏预防医学,2016,27(4):392-394.
[9]袁源,邢辉,王晓瑜,等.河南省柘城县艾滋病患者抗病毒治疗后HIV-1耐药发生率及其影响因素[J].中华流行病学杂志,2009,30(12):1273-1276.
[10]吴少慧,卢春明,姜凤霞,等.辽宁省艾滋病治疗患者耐药基因特征及分子流行病学分析[J].中华预防医学杂志,2011,45(7):619-624.
[11]颜苹苹,谢美榕,吴守丽,等.福建省艾滋病患者抗病毒治疗和耐药检测分析[J].中国人兽共患病学报,2008,24(10):896-900.
[12]Medeiros MS,Arruda EA,Guerrant RL,et al. Impact of the number of failed therapeutic regimes on the development of resistance mutations to HIV-1 in Northeast Brazil[J]. Braz J Infect Dis,2007,11(5):451-455.
[13]Johnsin H,Van Craenenbroeck E, Alan P, et al.Prediction of HIV-1drug susceptibility phenotype from the viral genotype using linear regressing modeling[J]. J Virol Methods,2007,145:47-55.