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目的 了解河南省部分地区HIV 1感染者抗病毒治疗临床效果 ,分析服药依从性与治疗效果关系 ;与未进行抗病毒治疗的患者相比较 ,分析治疗后病毒耐药性突变发生和流行情况。方法通过问卷调查、CD4 +细胞测定评价抗病毒治疗的临床效果 ;用RT PCR方法扩增HIV 1 pol区基因 ,进行基因型耐药性分析。结果 接受抗病毒治疗的人群中 ,坚持服药的病人 55.0 8%病情明显好转 ,而未坚持服药的病人仅有 6 .78%病情明显好转 ,服药依从性对病情趋势变化具有显著影响 (P <0 .0 5) ;接受抗病毒治疗的病人CD4 +淋巴细胞均值为 ( 4 2 9.38± 7.89)个 /μl,未治疗的病人CD4 +淋巴细胞均值为( 2 0 1 .4 3± 8.72 )个 /μl,治疗后患者CD4 +淋巴细胞计数显著高于未治疗的患者 (P <0 .0 5) ;基因型耐药性检测结果表明 ,相对于未经治疗的患者 ,经过抗病毒治疗的患者对逆转录酶抑制剂的耐药性突变显著高于未治疗的患者 ( χ2 =1 9.4 2 85,P <0 .0 5) ;治疗人群与未治疗人群对蛋白酶抑制剂的耐药突变差异无统计学意义 ( χ2 =0 .3478,P <0 .50 ) ;耐药性突变主要发生在CD4 +淋巴细胞 <2 0 0个 /μl病人中。结论 用国产抗病毒药物治疗可取得较好的临床效果 ,服药依从性对治疗效果有重要影响 ,治疗后耐药性突变发生率显著升高 ,因此提
Objective To understand the clinical effect of antiviral therapy in HIV-1 infected patients in some areas of Henan Province and to analyze the relationship between medication adherence and therapeutic effect. Compared with those without antiviral therapy, the occurrence and prevalence of virus-resistant mutations after treatment were analyzed. Methods The clinical effect of antiviral therapy was evaluated by questionnaire and CD4 + cell assay. The gene of HIV 1 pol was amplified by RT PCR and analyzed for genotypic drug resistance. Results Among the patients who received antiretroviral therapy, only 55.7% of the patients who insisted on medication improved significantly, while only 6.78% of those who did not adhere to medication showed a significant improvement. The medication compliance had a significant effect on the trend of the disease (P <0. .0 5). The average CD4 + lymphocyte count of patients receiving antiviral therapy was (4 2 9.38 ± 7.89) / μl, and that of untreated patients was (20 ± 3.43 ± 8.72) cells / μl, the CD4 + lymphocyte count of patients after treatment was significantly higher than that of untreated patients (P <0.05). The results of genotypic drug resistance test showed that compared with untreated patients, patients treated with antiviral therapy Mutations in resistance to reverse transcriptase inhibitors were significantly higher than those in untreated patients (χ2 = 1 9.4285, P <0.05); there were no differences in resistance mutations to protease inhibitors between treated and untreated populations Significance (χ2 = 0.3478, P <0.50). The drug-resistance mutations mainly occurred in CD4 + lymphocytes <200 cells / μl. Conclusions The treatment with domestic antiviral drugs can achieve better clinical effects. The medication compliance has an important effect on the treatment effect, and the incidence of drug-resistant mutations after treatment is significantly increased. Therefore,