摘要
目的比较HIV抗病毒治疗药物EFV与NVP治疗失败后基因型耐药突变位点及相关人口学信息分布的差异性。方法采用基因型耐药检测方法,通过反转录巢式聚合酶链反应(RT-nested-PCR)扩增血浆病毒载量大于1 000copies/ml的2014-2016年HIV抗病毒治疗失败患者Pol区基因,将扩增序列提交至斯坦福大学耐药检测网站进行比对获得耐药报告,应用多重对应分析方法,比较EFV和NVP耐药突变与人口学信息相关性差异。结果使用含EFV和NVP治疗失败患者共1 134例,K103N/S、V106I/M、V179D/E、Y181C/I/V、Y188LHC及G190A/S/E等为NNRTIs常见突变方式。单因素分析显示,接受含此两种药物方案治疗出现的基因型耐药在患者治疗时长、性别、突变出现及传播途径的差异有统计学意义(P<0.05),与病毒载量及CD4+T淋巴细胞计数的差异无统计学意义(P>0.05)。结论使用EFV方案男性静脉药瘾感染者治疗早期(<12月)极易出现V179D/E及V106I/M突变,在治疗中期(13-24月)则易出现K103N/S,对男性静脉药瘾者在治疗24个月内的服药依从性应给予更多的关注。NVP女性长期治疗(>25月)过程中,更易出现Y181C/I/V、Y188LHC及G190A/S/E等耐药突变方式,应加强对这一人群NVP耐药的监测。
Objective To analyze the difference between drug resistance genotypes among 1 134 HIV/AIDS patients who failed antiviral treatment with EFV and NVP and its related demographic information in Yunan province. Methods Genotype resistance detection method was used to amplify virus’ s Pol region in the plasma of the treatment failed patient who with a viral load greater than1 000 copies/ml by reverse transcription nested polymerase chain reaction(RT-nested-PCR). The amplified sequences were submitted to the drug resistance detection website of Stanford university for comparison, and drug resistance reports was obtained. Multiple correspondence analysis method was applied to compare the correlation differences between drug resistance mutations of EFV and NVP and demographic information. Results A total of 1 134 patients with EFV and NVP treatment failure were included. K103 N/S,V106 I/M,V179 D/E,Y181 C/I/V,Y188 LHC and G190 A/S/E were the common mutations of NNRTIs. Univariate analysis showed that in the case of treatment with these two drugs, the difference in the duration of treatment, gender, mutation, and route of transmission was statistically significant(P<0.05). There was no significant difference in viral load and CD4+T lymphocyte counts(P>0.05). Conclusions Male patients with intravenous drug addiction using EFV therapeutic regimen are prone to V179 D/E and V106 I/M mutations in the early stage(<12 months),and K103 N/S are prone to occur in the middle of treatment(13-24 months).More attention should be paid to the compliance of male intravenous drug addicts within 24 months of treatment. Women with long-term NVP treatment(>for 25 months) are more likely to have drugresistant mutations, such as Y181 C/I/V Y188 LHC and G190 A/S/E. Pay attention to the occurrence of drug resistance in the long-term use of NVP in women with sexually transmitted infections.
作者
潘小满
李健健
张米
刘家法
杨翠先
杨壁珲
董兴齐
PAN Xiaoman;LI Jianjian;ZHANG Mi;LIU Jiafa;YANG Cuixian;YANG Bihui;DONG Xingqi(School of Public Health,Kunming Medicine University,Kunming 650301,Yunnan Province,China;Yunnan Provincial Hospital of Infectious Disease,AIDS Care Center,Kunming 650301,Yunnan Province,China)
出处
《预防医学情报杂志》
CAS
2019年第12期1364-1369,共6页
Journal of Preventive Medicine Information
基金
“十三五”科技重大专项“艾滋病和病毒性肝炎等重大传染病防治项目”(项目编号：2018ZX10721102)
