摘要
目的了解2014-2015年云南省文山州免费抗病毒治疗获得性免疫缺陷综合征(简称艾滋病)感染者和艾滋病患者HIV-1基因型耐药发生情况及特点。方法收集文山州2014-2015年接受免费抗病毒治疗的艾滋病患者的临床及实验室资料,对抗病毒治疗持续6个月以上、病毒载量仍大于1 000copies/mL的患者进行基因型耐药检测,分析耐药发生情况及耐药毒株流行特点。结果 2014-2015年共计176例艾滋病患者发生病毒学失败,共检测基因型耐药176人次,获得可用序列137条。该人群中耐药发生率为62.0%(85/137)。在使用过的药物中,对奈韦拉平(NVP)、依非韦仑(EFV)高度耐药的有62(45.3%)、50(36.5%);对拉米夫定(3TC)、替诺福韦(TDF)、司他夫定(D4T)、齐多夫定(AZT)高度耐药的情况分别是31(22.6%)、12(8.8%)、8(5.8%)、2(1.5%),对蛋白酶抑制剂(PI)没有出现高度耐药的情况。耐药突变与PI相关的主要耐药基因突变位点有3例,占2.2%(3/137);M46IM、T74S和L33I各1例。与核苷类反转录酶抑制剂(NRTI)相关的突变中,突变位点发生频率最高的是M184V/I,为23.4%(32/137)。与非核苷类反转录酶抑制剂(NNRTI)的突变中,突变位点发生频率最高的是K103N/S,为27%(34/137)。137条完整基因序列中,主要为CRF08_BC亚型,共67例(48.9%);其次是CRF01_AE亚型,共49例(35.8%);CRF07_BC亚型有6例(4.4%);另外还有15例(10.9%)URFs。结论当前文山州的耐药发生率在增加,毒株正变得复杂化,重组毒株在逐渐增加,应加强监测,防止耐药毒株的传播。
Objective To understand the occurrence situation and characteristics of HIV-1genetic drug resistance strains of HIV infection/AIDS patients with free antiviral treatment in Wenshan Prefecture of Yunnan Province during 2014-2015.Methods The clinical and laboratory data in 176 HIV/AIDS patients with free antiviral treatment in Wenshan Prefecture during 2012-2014 were collected.The patients with antiviral treatment for continuous more than 6months and viral load still more than 1 000copies/mL were performed the genetic drug resistance testing.Then the occurrence situation of drug-resistance and prevalence characteristics of drug resistance strains were analyzed.Results The virologic failure occurred in 176 AIDS patients during 2014-2015,176case-times of genetic drug resistance were detected and 137 usable sequences were obtained.The occurrence rate of drug resistance in this population was 62.0%(85/137).In used drugs,62cases(45.3%)and 50cases(36.5%)were highly resistant to NVP and EFV;the highly resistance to 3TC,TDF,D4 Tand AZT had 31cases(22.6%),12cases(8.8%),8cases(5.8%)and 2cases(1.5%)respectively,no case of highly resistant to PI occurred.There were 3cases of drug resistance mutations related PI gene mutations,accounting for 2.2%(3/137);M46IM,T74 Sand L33Iin each 1case,respectively.Among the NRTI related mutations,the highest frequency of mutations was M184V/I,accounting for 23.4%(32/137).In the mutation with NNRTI,the highest frequency of mutations was K103N/S,which was 27%(34/137).Of all 137 complete gene sequences,67cases(48.9%)were mainly the CRF08_BC subtype,followed by CRF01_AE subtype(35.8%,49cases),CRF07_BC subtype(4.4%,6cases)and other types(10.9%,15cases).Conclusion The current drug resistance rate of HIV-1in Wenshan Prefecture is increasing.The virulent strains are becoming more complicated and more new recombinant strains are gradually increased.The monitoring should be strengthened for preventing the spread of drug-resistant virulent strains.
作者
刘家法
李健健
杨壁珲
张米
谢祺
杨翠先
朱宝生
LIU Jiafa LI Jianjian YANG Bihui ZHANG Mi XIE Qi YANG Cuixian ZHU Baosheng(AIDS Care Center ,Yunnan Provincial Hospital of Infectious Disease, Kunming ,Yunnan 650301, China Medical College, Kunming University of Science and Technology, Kunming ,Yunnan 650500, China Genetic Diagnosis Center ,Yunnan Provincial First People's Hospital ,Kunming,Yunnan 650032 ,China)
出处
《国际检验医学杂志》
CAS
2017年第3期307-310,共4页
International Journal of Laboratory Medicine
基金
云南省卫生科技计划项目(2014NS363)
关键词
人类免疫缺陷病毒
抗病毒治疗
基因亚型
基因型耐药
human immunodeficiency virus
antiviral treatment
genetic subtype
genetic drug resistance