摘要
目的了解重庆地区接受一线抗反转录病毒治疗(antiretroviral therapy,ART)后发生病毒学失败的HIV-1感染者耐药情况。方法回顾性收集整理2015年5月—2020年6月在重庆市公共卫生医疗救治中心接受一线ART 1年后出现病毒学失败患者的临床资料,通过实时荧光定量(RT)-PCR测定HIV-1载量并扩增HIV-1基因,进行基因型耐药性分析,采用统计学卡方检验分析病毒学失败率、耐药发生率、耐药位点分布以及HIV-1基因型分布。采用Excel 2016进行数据收集、整理与图表制作,并分析病毒学失败率、耐药发生率、耐药位点分布和HIV-1基因型分布。结果在3305例接受一线ART的患者中,348例(10.5%)出现病毒学失败,其中319例对至少一种抗病毒药物耐药。非核苷类反转录酶抑制剂(NNRTI)耐药率为99.1%(316/319),其中奈韦拉平(nevirapine,NVP)、地拉韦定(delavirdine,DLV)和依非韦仑(efavirenz,EFV)耐药率均超过95%;核苷类反转录酶抑制剂(NRTI)耐药发生率达91.5%(292/319),其中拉米夫定(lamivudine,3TC)和恩曲他滨(emtricitabine,FTC)耐药发生率均超过90%,齐多夫定(zidovudine,AZT)和蛋白酶抑制剂(protease inhibitor,PI)类耐药发生率低。M184V/I和K65R/N是NRTI类药物最常见的基因突变位点,K103N/R/S、G190A/S/E/Q、V179D/E和V106M/A是NNRTI类药物常见的基因突变位点;无论是否存在耐药,HIV-1亚型均与我国主要流行亚型相近。结论该院一线ART治疗失败者耐药发生率高,耐药是HIV-1感者病毒学失败的主要原因;耐药最为严重的药物包括NVP、DLV、EFV、3TC和FTC,AZT和PI类药物耐药发生率低;耐药与HIV-1基因型无相关性。
Objective To investigate drug resistance in HIV-1 infected patients virologically failing first-line antiretroviral treatments in Chongqing.Methods Clinical data of HIV-1 infected patients were collected and reviewed after 1 year of first-line antiretroviral therapy in our hospital from May 2015 to May 2020.Real time fluorescent quantitative PCR(RT-PCR)was used to detect HIV-1 load and amplify HIV-1 gene for genotypic analysis of resistant strains.The rates of virological failure,drug resistance,distribution of drug resistance sites,and HIV-1 genotypes were analyzed by Chi square test.Excel 2016 was used for data collection,processing,and chart making,and analysis of virological failure rate,incidence of drug resistance,distribution of drug resistance sites,and HIV-1 genotypes.Results Of the 3305 patients receiving first-line antiviral therapy,348(10.5%)experienced virological failure and their HIV-1 RNA levels were over1000 copies/mL.At least one resistance-related mutation was found in 319 patients.Nonnucleoside reverse transcriptase inhibitor(NNRTI)resistance was identified in 99.1%(316/319)of the patients.Nucleoside reverse transcriptase inhibitor(NRTI)resistance was detected in 91.5%(292/319)of the patients.The incidence of resistance was higher than 95%to nevirapine(NVP),delavirdine(DLV),and efavirenz(EFV)and higher than 90%to lamivudine(3TC)and emtricitabine(FTC).The incidence of zidovudine(AZT)and protease inhibitors(PIs)resistance was lower.M184V/I and K65R/N were the most frequent sites of mutation for NRTIs.K103N/R/S,G190A/S/E/Q,V179D/E and V106M/A were the most detectable sites of mutation for NNRTIs.The HIV-1 subtypes were similar to the prevalent strains in China,regardless of drug resistance.Conclusions The incidence of drug resistance is relatively high among the HIV-1 infected patients failing first-line antiretroviral therapy in Chongqing,which indicates that drug resistance is the main cause of virological failure.The incidence of resistance to NVP,DLV,EFV,3TC,and FTC is alarmingly high.However
作者
鲁雁秋
王静
陈耀凯
李俊刚
LU Yanqiu;WANG Jing;CHEN Yaokai;LI Jungang(Department of Infectious Diseases,Chongqing Public Health Medical Center,Chongqing 400036,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2021年第4期427-431,共5页
Chinese Journal of Infection and Chemotherapy
基金
“十三五”国家科技重大专项课题(2018ZX10302104,2017ZX10201101-001-011)
重庆市计生委医学科研项目(2010-2-256,2016ZDXM033)
重庆市公共卫生医疗救治中心青年科研创新基金(19QNKYXM09)
北京佑安医院专科联盟科研专项基金(LM202021)。
关键词
人类免疫缺陷病毒
抗反转录病毒治疗
耐药突变
回顾性研究
human immunodeficiency virus
antiretroviral therapy
drug-resistant mutation
retrospective analysis
