CAJ | 학술논문

目的了解HIV耐药毒株在山东省AIDS抗病毒治疗人群中的流行及演变.方法对山东省抗病毒治疗时间满1年的324例AIDS患者,使用荧光实时定量PCR( NucliSens EasyQ系统)进行HIV病毒载量检测,对结果大于1000拷贝/ml的样本采用基因型耐药检测白建方法(in house)进行HIV耐药检测.对耐药者既往(治疗前、治疗中)样本进行耐药检测,分析耐药株的演变状况.结果 HIV抗病毒治疗满1年人群耐药率为6.2％ (20/324),有耐药突变位点但不耐药为0.6％ (5/324)；核苷类与非核苷类耐药突变位点占所测突变位点的93.1％ (94/101),蛋白酶类仅占6.9％ (7/101)；M184V及Y181C位点在25份样本中出现突变频率最高,分别为48.0％( 12/25)和32.0％ (8/25).演变研究发现,20.0％( 2/10)的耐药者属于原发耐药；最早在治疗6个月后检测到了耐药；病毒株存在从无耐药突变位点向有耐药突变位点、从仅有耐药突变位点而不耐药向耐药、从对少种类药物低水平耐受向对多种类药物高水平耐受的演变现象,也存在突变位点相互影响使得对某种药物耐受程度降低的演变现象.结论 HIV耐药毒株在山东省AIDS抗病毒治疗人群中处于较低流行水平,耐药株的演变现象复杂.
목적 료해HIV내약독주재산동성AIDS항병독치료인군중적류행급연변.방법 대산동성항병독치료시간만1년적324례AIDS환자,사용형광실시정량PCR( NucliSens EasyQ계통)진행HIV병독재량검측,대결과대우1000고패/ml적양본채용기인형내약검측백건방법(in house)진행HIV내약검측.대내약자기왕(치료전、치료중)양본진행내약검측,분석내약주적연변상황.결과 HIV항병독치료만1년인군내약솔위6.2％ (20/324),유내약돌변위점단불내약위0.6％ (5/324)；핵감류여비핵감류내약돌변위점점소측돌변위점적93.1％ (94/101),단백매류부점6.9％ (7/101)；M184V급Y181C위점재25빈양본중출현돌변빈솔최고,분별위48.0％( 12/25)화32.0％ (8/25).연변연구발현,20.0％( 2/10)적내약자속우원발내약；최조재치료6개월후검측도료내약；병독주존재종무내약돌변위점향유내약돌변위점、종부유내약돌변위점이불내약향내약、종대소충류약물저수평내수향대다충류약물고수평내수적연변현상,야존재돌변위점상호영향사득대모충약물내수정도강저적연변현상.결론 HIV내약독주재산동성AIDS항병독치료인군중처우교저류행수평,내약주적연변현상복잡.
Objective To understand the prevalence and evolution of HIV drug-resistant strains in people who live with HIV/AIDS (PLWHA) during HIV antiretroviral therapy in Shandong province.Methods Viral load testing was performed by using fluorescence real-time quantitative PCR ( NucliSens EasyQ system) on 324 patients who were under HIV antiretroviral therapy(ART) over 1 year in Shandong province.HIV resistance testing was conducted on the samples with more than 1000 copies/ml by using genotypic resistance testing method established in our lab.We tested the samples from drug-resistant patients before and after treatment to analyze the evolution of HIV resistant strains.Results The resistance rate for the patients under HIV ART over 1 year was 6.2％ ( 20/324 ).The rate of drug-resistant mutation,but not resistant to ART was 0.6％ (5/324).Nucleoside reverse transcriptase inhibitor(NRTIs) and non-NRTIs (NNRTIs) accounted for 93.1％ (94/101) and protein inhibitors(PIs) accounted only 6.9％ (7/101)of all mutations.M184V (48.0％,12/25 ) and Y181C (32.0％,8/25 ) were the most frequent mutations among 25 samples.Our research showed 20.0％ (2/10) patients were resistant to primary ART and 1 patient was detected drug resistance in 6 months after ART treatment.HIV evolved from wild type to drug resistant virus,from low level to high level drug resistance,and from resistance to few to multiple drugs.In addition,interactions between mutations may influence the sensitivity of patients to other drug treatment.Conclusion The prevalence of HIV drug-resistant strains in Shandong province is still at a low level,but its evolution is complex.