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目的了解上海地区伴有HIV-1原发性耐药的艾滋病病毒感染者/艾滋病患者(HIV/AIDS)对高效抗反转录病毒治疗(HAART)效果的影响,评估长期抗病毒治疗方案,为调整治疗策略提供依据。方法从上海市艾滋病治疗数据库中随机选取2007-2013年期间被诊断为HIV-1的感染者,在未治疗前进行原发性耐药检测。对其中原发性耐药的病例进行1~7年不等的随访检测,通过CD4+T淋巴细胞计数及病毒载量结果评估抗病毒治疗效果。结果 1 543例HIV-1感染者中发现HIV原发性耐药42例,其中失访8例,死亡1例,停药1例,最后获得32例原发性耐药者。32例中非核苷类反转录酶抑制剂(NNRTI)耐药相关突变11例,核苷类反转录酶抑制剂(NRTI)耐药相关突变7例,蛋白酶抑制剂(PI)耐药相关突变6例;对NRTIs和NNRTIs同时耐药突变有3例,同时发生对PIs和NNRTIs的耐药相关突变1例,同时发生对PIs和NRTIs的耐药相关突变2例;对整合酶抑制剂(IN)耐药相关突变2例,平均原发性耐药率为2.7%。随访监测CD4+T淋巴细胞计数和病毒载量变化结果显示,32例患者的CD4+T淋巴细胞数量在HAART治疗前和治疗后的0.5、1、2、3、4、5、6和7年(±1个月)时分别为249.5±157.4、304.9±188.7、356.3±206.4、441.4±245.7、455.4±256.8、453.2±168.5、458.2±202.4、454.0±66.8和432.0±100.4个/$l。服药依从性指标评估显示所有病例均每年检测病毒载量,除了2例病例病毒载量为600拷贝/ml和700拷贝/ml外,其余病毒载量检测均低于检测下限,病毒抑制率为100%。上述病例在随访期间,均因毒副反应而更换为其他一线药物或二线药物。结论通过随访观察上海地区伴原发性耐药的HIV/AIDS对抗病毒的治疗效果,在原发性耐药率低的流行地区,如果治疗管理规范,患者服药依从性好,并经常开展公共卫生原发性耐药监测,在条件有限的情况下可不考虑进行治疗前原发性耐药检测。
Objective To investigate the effect of HIV / AIDS on HAART in Shanghai with primary drug-resistant HIV-1 and to evaluate long-term antiviral treatment Adjust the treatment strategy to provide the basis. Methods Inpatients with HIV-1 who were diagnosed as HIV-1 from 2007 to 2013 were selected randomly from the Shanghai AIDS Treatment Database and primary drug resistance tests were conducted before treatment. The cases of primary resistance were followed up for 1 to 7 years, and the antiviral therapeutic effect was evaluated by CD4 + T lymphocyte count and viral load. Results Among the 5443 HIV-1 infected patients, 42 were found to be HIV-1-resistant, of which 8 were lost to follow-up, 1 died, 1 was discontinued, and 32 were initially drug resistant. There were 11 cases of NNRTI mutations, 7 cases of NRTI resistance related mutations, and 1 cases of protease inhibitor (PI) resistance in 32 cases of NNRTI. Mutation in 6 cases. There were 3 cases of simultaneous drug-resistance mutations in NRTIs and NNRTIs, 1 case of drug-related mutations in PIs and NNRTIs, 2 cases of drug-resistance-related mutations in PIs and NRTIs, 2 cases of integrin inhibitor IN) resistance-related mutations in 2 cases, the average primary resistance rate was 2.7%. Follow-up monitoring of CD4 + T-lymphocyte count and changes in viral load showed that 32 patients had CD4 + T lymphocytes at pre-HAART and 0.5,1,2,3,4,5,6 and 7 years after treatment (± 1 month) were 249.5 ± 157.4, 304.9 ± 188.7, 356.3 ± 206.4, 441.4 ± 245.7, 455.4 ± 256.8, 453.2 ± 168.5, 458.2 ± 202.4, 454.0 ± 66.8, and 432.0 ± 100.4 pcs, respectively. Drug compliance assessment showed that all cases were tested for viral load every year, except for two cases of viral load of 600 copies / ml and 700 copies / ml, the other detection of viral load were lower than the detection limit, the virus inhibition rate of 100 %. During the follow-up period, all the above cases were replaced by other first-line drugs or second-line drugs due to side effects. Conclusions The anti-virus efficacy of primary HIV / AIDS-resistant HIV / AIDS in Shanghai is observed through follow-up. In the endemic areas where the prevalence of primary drug resistance is low, if the treatment regimen is followed and the patient’s medication compliance is good, and public hygiene Primary drug resistance monitoring, in conditions of limited circumstances may not be considered for the detection of pre-treatment of primary drug resistance.