抗病毒治疗病毒学失败的HIV感染/AIDS患者基因型耐药发生情况及其影响因素
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摘要
目的调查抗病毒治疗病毒学失败的HIV感染/AIDS患者基因型耐药的发生情况及其影响因素。方法纳入首次接受抗病毒治疗并发生病毒学失败的311例HIV感染者/AIDS患者。收集所有患者的基线和随访资料,并进行基因型耐药检测。采用Logistic回归模型分析患者发生基因型耐药的影响因素。结果共167例(53. 7%)患者发生基因型耐药。基线年龄、婚姻状态、基线CD4+T淋巴细胞计数、基线病毒载量水平、依从性、治疗方案、治疗时间、基线临床分期、治疗前症状数量及机会性感染种数均是抗病毒治疗病毒学失败的HIV感染/AIDS患者发生基因型耐药的影响因素(均P <0. 05)。结论抗病毒治疗后病毒学失败的HIV感染/AIDS患者的基因型耐药发生率较高,且基因型耐药的发生受多种因素影响。
Objective To investigate the incidence of genotypic resistance and its influencing factors in HIV-infected/AIDS patients with virological failure in antiretroviral therapy. Methods A total of 311 HIV-infected/AIDS patients with virological failure in first antiretroviral therapy were enrolled. Baseline and follow-up data were collected from all the patients,and genotypic resistance testing was performed. Logistic regression model was used to analyze the factors influencing incidence of genotypic resistance in the patients. Results Genotypic resistance occurred in 167 cases( 53. 7%). Baseline age,marital status,baseline CD4+T lymphocyte count,baseline viral load level,adherence,therapeutic regimen,treatment duration,baseline clinical stage,number of pretreatment symptoms,species of pretreatment opportunistic infections were influencing factors of incidence of genotypic resistance in HIV-infected/AIDS patients with virological failure in antiretroviral therapy( all P < 0. 05). Conclusion HIV-infected/AIDS patients with virological failure in antiretroviral therapy experience a higher incidence rate of genotypic resistance,and the incidence of genotypic resistance is affected by various factors.
Objective To investigate the incidence of genotypic resistance and its influencing factors in HIV-infected/AIDS patients with virological failure in antiretroviral therapy. Methods A total of 311 HIV-infected/AIDS patients with virological failure in first antiretroviral therapy were enrolled. Baseline and follow-up data were collected from all the patients,and genotypic resistance testing was performed. Logistic regression model was used to analyze the factors influencing incidence of genotypic resistance in the patients. Results Genotypic resistance occurred in 167 cases( 53. 7%). Baseline age,marital status,baseline CD4+T lymphocyte count,baseline viral load level,adherence,therapeutic regimen,treatment duration,baseline clinical stage,number of pretreatment symptoms,species of pretreatment opportunistic infections were influencing factors of incidence of genotypic resistance in HIV-infected/AIDS patients with virological failure in antiretroviral therapy( all P < 0. 05). Conclusion HIV-infected/AIDS patients with virological failure in antiretroviral therapy experience a higher incidence rate of genotypic resistance,and the incidence of genotypic resistance is affected by various factors.
引文
[1]杨文杰. 2005~2014年河南省艾滋病患者抗病毒治疗后生存及影响因素分析[D].郑州:郑州大学,2015.
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[4] Sabin CA,Hill T,Lampe F,et al. Treatment exhaustion of highly active antiretroviral therapy(HAART)among individuals infected with HIV in the United Kingdom:multicentre cohort study[J]. BMJ,2005,330(7 493):695.
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[6] World Health Organization. Antiretroviral therapy for HIV infection in adults and adolescents:recommendations for a public health approach:2010 revision[R]. Geneva:WHO Press,2010:86.
[7]赵宏儒,路新利,李岩,等.抗HIV治疗失败后HIV-1耐药基因的变异[J].中国感染控制杂志,2013,12(4):247-250,270.
[8]李太生.如何提高我国抗艾滋病病毒治疗成功率[J].中华医学杂志,2011,91(21):1 441-1 442.
[9] Carvajal-Rodriguez A,Crandall KA,Posada D. Recombination favors the evolution of drug resistance in HIV-1 during antiretroviral therapy[J]. Infect Genet Evol,2007,7(4):476-483.
[10] Sigaloff KC,Hamers RL,Wallis CL,et al. Unnecessary antiretroviral treatment switches and accumulation of HIV resistance mutations; two arguments for viral load monitoring in Africa[J]. J Acquir Immune Defic Syndr,2011,58(1):23-31.
[2] Dabis F,Newell ML,Hirschel B. HIV drugs for treatment,and for prevention[J]. Lancet,2010,375(9731):2 056-2 057.
[3] Le T,Chiarella J,Simen BB,et al. Low-abundance HIV drugresistant viral variants in treatment-experienced persons correlate with historical antiretroviral use[J]. PLo S One,2009,4(6):e6079.
[4] Sabin CA,Hill T,Lampe F,et al. Treatment exhaustion of highly active antiretroviral therapy(HAART)among individuals infected with HIV in the United Kingdom:multicentre cohort study[J]. BMJ,2005,330(7 493):695.
[5] De Gruttola V,Dix L,D'Aquila R,et al. The relation between baseline HIV drug resistance and response to antiretroviral therapy:re-analysis of retrospective and prospective studies using a standardized data analysis plan[J]. Antivir Ther,2000,5(1):41-48.
[6] World Health Organization. Antiretroviral therapy for HIV infection in adults and adolescents:recommendations for a public health approach:2010 revision[R]. Geneva:WHO Press,2010:86.
[7]赵宏儒,路新利,李岩,等.抗HIV治疗失败后HIV-1耐药基因的变异[J].中国感染控制杂志,2013,12(4):247-250,270.
[8]李太生.如何提高我国抗艾滋病病毒治疗成功率[J].中华医学杂志,2011,91(21):1 441-1 442.
[9] Carvajal-Rodriguez A,Crandall KA,Posada D. Recombination favors the evolution of drug resistance in HIV-1 during antiretroviral therapy[J]. Infect Genet Evol,2007,7(4):476-483.
[10] Sigaloff KC,Hamers RL,Wallis CL,et al. Unnecessary antiretroviral treatment switches and accumulation of HIV resistance mutations; two arguments for viral load monitoring in Africa[J]. J Acquir Immune Defic Syndr,2011,58(1):23-31.