摘要
目的:分析近年来苏州地区人类免疫缺陷病毒(human immunodeficiency virus-1,HIV-1)感染患者对抗反转录病毒药物的耐药情况及其基因突变位点。方法:选取医院2019年—2021年收治的苏州地区艾滋病抗反转录病毒治疗(antiretroviral therapy,ART)失败的HIV患者157例病历资料,检测患者外周静脉血标本中病毒的毒株亚型及其耐药基因突变特点。结果:157例HIV患者样本中,90例患者(57.32%)pol基因区扩增成功,患者不同性别、传播途径、基线CD4 T细胞水平、合并肝炎、合并梅毒和确诊到治疗间隔时间的耐药突变比经比较其差异有统计学意义(P<0.05);71例HIV患者发生耐药突变,其对整合酶链转移抑制剂、蛋白酶抑制剂、核苷逆转录酶抑制剂、非核苷类逆转录酶抑制剂的耐药率分别为1.41%、4.22%、78.87%和94.37%;HIV-1毒株亚型以CRF01_AE为主(40例,占56.32%),其次为B亚型(9例,占12.68%)和A亚型(8例,占11.27%);此外,还发现CRF67_01B、CRF01_AE/B和CRF07_BC等其他9种耐药重组亚型。结论:苏州地区HIV-1感染者采用ART治疗时,应重点关注核苷逆转录酶抑制剂与非核苷类逆转录酶抑制剂的耐药变迁情况,并合理选用抗病毒药物治疗,以确保其疗效。
Objective: To analyze the drug-resistant characteristics and mutant site in HIV-1 infected patients accepting antiretroviral therapy in Suzhou district from 2019 to 2021. Methods: A total of 157 patients with HIV admitted to author’s hospital in Suzhou area from 2019 to 2021 were selected to detect the subtypes of virus strains and mutation characteristics of drug resistance genes in peripheral venous blood. Results: Pol gene region was successfully amplified in 90 of 157 HIV patients(57.32%), and the ratio of drug-resistant mutations in positive patients was compared with gender, route of transmission, baseline CD4 T cell level, hepatitis, syphilis, and the interval between diagnosis and treatment. The results were statistically significant(P<0.05). 71 HIV patients developed drug-resistant mutations,The drug resistance rates to integrase strand transfer inhibitors(INSTIs), protease inhibitors(PIs), nucleoside reverse transcriptase inhibitors(NRTIs) and and non-nucleoside reverse transcriptase inhibitors(NNRTIs) were 1.41%, 4.22%,78.87% and 94.37%, respectively. The main subtype of HIV-1 strain was CRF01_AE(40 cases, 56.33%), followed by subtype B(9 cases, 12.68%) and subtype A(8 cases, 11.27%). In addition, 9 other drug-resistant recombinant subtypes were found, including CRF67_01 B, CRF01_AE/B and CRF07_BC. Conclusion: When HIV-1 infected patients in Suzhou are treated with ART, attention should be paid to the changes of drug resistance between nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors, and antiviral drugs should be rationally selected for treatment to ensure its efficacy.
作者
许炜璐
魏志强
黄金龙
刘锦
钱峰
朱月萍
XU Wei-lu;WEI Zhi-qiang;HUANG Jin-long;LIU Jin;QIAN Feng;ZHU Yue-ping(The Fifth People's Hospital of Suzhou,Suzhou Jiangsu 215131,China)
出处
《抗感染药学》
2021年第12期1733-1738,共6页
Anti-infection Pharmacy
基金
苏州市卫生和计划生育委员会临床重点病种诊疗课题(编号:LCZX201717)
苏州市民生科技项目(编号:SYSD2018163)
江苏省自然科学基金项目(编号:BK20181178)。
关键词
艾滋病
耐药
抗病毒治疗
基因亚型
AIDS
drug resistance
antiretroviral therapy
gene subtypes
