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目的了解四川省乐山市2014年接受HIV-1抗病毒治疗6个月以上HIV/AIDS患者的治疗效果及耐药突变情况。方法采集2014年全市范围内接受抗病毒治疗6个月以上的441例HIV/AIDS患者EDTA-K2抗凝全血进行病毒载量检测,对结果>1 000 cps/ml的样本进行核酸PCR和pol基因测序,登陆美国斯坦福大学HIV耐药数据库在线分析耐药突变情况。结果 441例抗病毒治疗患者中,317例(71.88%)病毒载量<400cps/ml,118例(26.75%)病毒载量>1 000cps/ml,84例样本核酸扩增阳性,37例出现不同程度耐药,耐药率为9.09%,比2011年上升了6.04个百分点。37例耐药毒株中23例(62.16%)为CRF07_BC重组亚型,13例(35.14%)为CRF01_AE重组亚型,1例(2.70%)为B亚型。耐药患者中,29例(78.38%)患者对核苷类反转录酶抑制剂(NRTIs)耐药,36例(97.30%)患者对非核苷类反转录酶抑制剂(NNRTIs)耐药,2例(5.41%)患者对蛋白酶抑制剂(PIs)耐药。耐药突变位点主要为M184(70.3%)、G190(37.8%)、Y181(27.0%)、D67(24.3%)、K70(24.3%)和V106(24.3%)。结论乐山市2014年抗病毒治疗耐药率上升,对核苷类逆转录酶抑制剂(NRTIs)和非核苷类逆转录酶抑制(NNRTIs)耐药及交叉耐药严重,并出现了针对蛋白酶抑制剂(PIs)的耐药毒株。随着乐山市抗病毒治疗工作的广泛开展,应加强对抗病毒治疗患者的可持续性和规范性治疗的管理,提高治疗的有效性,延缓耐药毒株产生的速度,及时进行耐药监测,控制艾滋病的传播。
Objective To understand the therapeutic effect and drug-resistance mutation of HIV / AIDS patients who received HIV-1 antiviral therapy for more than 6 months in Leshan, Sichuan Province. Methods A total of 441 HIV / AIDS patients with anti-viral EDTA-K2 anticoagulant whole blood over 6 months of ART were enrolled and tested for viral load in 2014, and samples of> 1 000 cps / ml were analyzed for nucleic acid PCR and pol Gene sequencing, visit the United States Stanford University HIV drug resistance database online analysis of drug resistance mutations. Results Of 441 patients with antiviral therapy, 317 (71.88%) had viral load of <400 cps / ml, 118 (26.75%) had viral load of> 1000 cps / ml and 84 samples had positive nucleic acid amplification and 37 The drug resistance rate was 9.09%, an increase of 6.04 percentage points from 2011. Of the 37 drug resistant strains, 23 (62.16%) were CRF07_BC recombinant subtypes, 13 (35.14%) were CRF01_AE recombinant subtypes and 1 (2.70%) were subtypes B. Among the drug-resistant patients, 29 (78.38%) patients were resistant to nucleoside reverse transcriptase inhibitors (NRTIs) and 36 (97.30%) were resistant to non-nucleoside reverse transcriptase inhibitors (NNRTIs) Two patients (5.41%) were resistant to protease inhibitors (PIs). The main mutational sites were M184 (70.3%), G190 (37.8%), Y181 (27.0%), D67 (24.3%), K70 (24.3%) and V106 (24.3%). Conclusion The resistance rate of antiretroviral therapy in Leshan increased in 2014, the resistance to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) and resistance to cross-resistance were serious, and protease inhibition (PIs) resistant strains. With the extensive anti-virus treatment work in Leshan City, we should strengthen the management of patients with anti-virus treatment of sustainability and normative treatment to improve the effectiveness of treatment, delay the speed of drug-resistant strains, timely drug resistance monitoring, Control the spread of AIDS.