CAJ | 학술논문

目的建立耐药变异研究队列,以明确我国HIV/AIDS患者抗病毒治疗反应及耐药变异发生和变化情况.方法招募HIV感染者116例,每半年进行1次问卷调查,同时进行CD4+ T淋巴细胞计数、病毒载量和耐药检测.结果应用AZT/DDI/NVP或D4T/DDI/NVP方案者,治疗36个月后CD4+ T淋巴细胞计数仍维持在较高水平[(470±251)个/ml],病毒载量低于治疗前水平,随着治疗时间的延长,耐药逐渐增加;更换为AZT/3TC/NVP或D4T/3TC/NVP方案者,随着治疗时间的延长,CD4+ T淋巴细胞计数逐步下降,病毒载量升高,耐药明显上升;治疗前仅1例存在原发非核苷类逆转录酶抑制剂(NNRTI)高度耐药突变,治疗6个月有2例出现了交叉耐药,治疗12个月后出现了蛋白酶抑制剂(PI)LPV的中度耐药,治疗18个月后NNRTI的高度耐药明显增加,治疗36个月后5例出现多药耐药和交叉耐药.结论我国艾滋病抗病毒治疗前原发耐药很少,随着治疗时间延长,耐药突变逐渐增加,虽然治疗方案较少,但坚持长期治疗仍能保持治疗效果,建议根据耐药检测结果更换治疗方案.
목적 건립내약변이연구대렬,이명학아국HIV/AIDS환자항병독치료반응급내약변이발생화변화정황.방법 초모HIV감염자116례,매반년진행1차문권조사,동시진행CD4+ T림파세포계수、병독재량화내약검측.결과 응용AZT/DDI/NVP혹D4T/DDI/NVP방안자,치료36개월후CD4+ T림파세포계수잉유지재교고수평[(470±251)개/ml],병독재량저우치료전수평,수착치료시간적연장,내약축점증가;경환위AZT/3TC/NVP혹D4T/3TC/NVP방안자,수착치료시간적연장,CD4+ T림파세포계수축보하강,병독재량승고,내약명현상승;치료전부1례존재원발비핵감류역전록매억제제(NNRTI)고도내약돌변,치료6개월유2례출현료교차내약,치료12개월후출현료단백매억제제(PI)LPV적중도내약,치료18개월후NNRTI적고도내약명현증가,치료36개월후5례출현다약내약화교차내약.결론아국애자병항병독치료전원발내약흔소,수착치료시간연장,내약돌변축점증가,수연치료방안교소,단견지장기치료잉능보지치료효과,건의근거내약검측결과경환치료방안.
Objective To build the cohort of drug resistance and analyze treatment efficiency of AIDS patients and situation of drug resistant mutations among HIV-1 infected individuals.Methods A cohort of 116 HIV-1 infected patients was built and their treatment progress were acquired once every 6 months.At the sanle time CD4+ T cell counts and HIV-1 viral load were measured and genotyping for drug resistance was determined by a home brew nested PCR.Results The CD4+ T cell count(470±251/ml)was higher than that before treatment in patients who were treated by AZT/DDI/NVP or D4T/DDL/NVP.The viral load was lower than that before treatmenL The drug resistant mutation frequency increased gradually along with treatment.The CD4+ T cell count was decreased and viral load was increased and the prevalence of drug resistant mutation was increased in the patients who changed regimens to AZT/3TC/NVP or D41/3TC/NVP.Only one primary mutation that was resistant to non-nucleoside reverse transcriptase inhibitors (NNRTIs)was detected in the naive patients.The cross-resistant mutation was detected in two patients after 6 months treatment. The intermediate resistance to lopinavir(LPV) was detected after 12 months treatment.The prevalence of high-grade resistances to NNRTIs was increased obviously,and the prevalence of multi-resistance and cross-resistance was detected in 5 patients after 36 months treatment.Conclusions The prevalence of primary mutation was rare in naive HIV-1 infected patients.The prevalence of drug resistant mutation was inereased gradually along with treatment.Ahhough few regimens were available,the treatment effect could last relatively long period of time if patients keep taking medicine stably.The regimens could be changed according to the results of drug resistant test.