摘要
目的了解接受抗病毒治疗(ART)的艾滋病病毒(HIV)感染者/艾滋病病人停药后,病毒载量及耐药突变位点变化的情况。方法在河南和安徽两县市,回顾性队列调查接受ART的停药病人,分析停药前后病毒载量、CD4+T淋巴细胞(简称CD4细胞)数及HIV耐药变化情况。结果共纳入64名停药病人,停药12个月和24个月后分别随访到52人和40人;在停药前,有34人血浆病毒载量≥1000拷贝/mL,CD4细胞中位数为285个/μL,停药后12个月和24个月,病毒载量≥1000拷贝/mL的病人分别有48人和40人,CD4细胞中位数分别为223个/μL和282个/μL;停药前共有19人存在耐药突变位点,停药12个月和24个月后,分别有20人和10人有耐药位点;8个核苷类耐药突变位点,如M41L、K65R、D67G、K70N、L74V、F116Y、L210W、T215Y在停药后12个月即消失,3个非核苷类耐药突变位点,如K101E、H221Y、K238RT停药12个月消失,Y188HL在停药后24个月检测不到,而有些非核苷类耐药突变位点K103NRS、Y181C、G190ARS,在停药后24个月仍然存在。结论接受抗病毒治疗的艾滋病病人停药后,病毒载量明显上升,耐药突变位点以不同速度发生变化,核苷类耐药突变位点比非核苷类耐药突变位点更易消失。
Objective To investigate the changes of viral load and drug resistance mutations during antiretroviral therapy(ART) discontinuation in AIDS patients. Methods Retrospective cohort study was conducted among patients discontinuing ART at two counties in Henan and Anhui provinces. Plasma viral load, CD4^+ T cell counts, and drug resistance mutations were analyzed during ART discontinuation. Results A total of 64 patients who discontinued ART were included in the study. After 12 and 24 months of ART stop, 52 and 40 patients were visited, respectively. Prior to ART discontinuation, 34 patients had a viral load of more than or equal to 1000 copies/mL, the number of patients increased to 48 and 40 after 12 and 24 months of ART stop, respectively. Before ART stop, the median CD4^+ T cell counts were 285 cells/μL, and changed to 223 cells/μL and 282 cells/μL after 12 and 24 months, respectively. Before, after 12 and 24 months of ART stop, 19, 20 and 10 patients harbored HIV drug resistant variants, respectively. Nucleoside reverse transcriptase inhibitors(NRTIs)-related drug resistant mutations such as M41L, K65R, D67G, K70N, L74V, F116Y, L210W and T215Y disappeared after 12 months of ART stop. Non-nucleotide reverse transcriptase inhibitors(NNRTIs)-related drug resistantmutations like K101 E, H221 Y, and K238 RT were undetectable after 12 months, Y188HL undetectable after 24 months, while three NNRTIs-related drug-resistant mutations including K103NRS, Y181C and G190ARS were still detectable after 24 months of ART stop. Conclusion Among patients discontinuing ART, the viral load significantly increases. The drug resistance sites change at different speeds;NRTIs-related drug resistant mutations are more likely to disappear than NNRTIs-related ones.
作者
李苗苗
周佳佳
曹丕
吴建军
闫江舟
宋畅
冯毅
阮玉华
邢辉
邵一鸣
廖玲洁
LI Miaomiao;ZHOU Jiajia;CAO Pi;WU Jianjun;YAN Jiangzhou;SONG Chang;FENG Yi;RUAN Yuhua;XING Hui;SHAO Yiming;LIAO Lingjie(National Center for AIDS/STD Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China;Anhui Provincial Center for Disease Control and Prevention,Hefei 230601;Henan Provincial Center for Disease Control and Prevention,Zhengzhou 450016)
出处
《中国艾滋病性病》
CAS
CSCD
北大核心
2020年第4期351-354,共4页
Chinese Journal of Aids & STD
基金
国家科技重大专项(2017ZX10201101)
国家科技重大专项(2018ZX10721102)。
