中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2011年
21期
1443-1447
,共5页
李韩平%郭伟%李宏%王哲%刘永健%鲍作义%李林%庄道民%刘思扬%王铮%王晓林%李敬云
李韓平%郭偉%李宏%王哲%劉永健%鮑作義%李林%莊道民%劉思颺%王錚%王曉林%李敬雲
리한평%곽위%리굉%왕철%류영건%포작의%리림%장도민%류사양%왕쟁%왕효림%리경운
HIV-1%抗病毒药%抗药性,病毒
HIV-1%抗病毒藥%抗藥性,病毒
HIV-1%항병독약%항약성,병독
HIV-1%Antiviral agents%Drug resistance,viral
目的 揭示在中国农村特殊的抗病毒治疗模式下HIV-1耐药发生的规律.方法 2004年3月在中国河南某农村招募75例于2003年9月开始接受齐多夫定(AZT)+去羟肌苷(ddI)+奈韦拉平(NVP)治疗的艾滋病患者,进行封闭式队列研究,共随访12次、788人次、历时6年3个月,每次随访均检测病毒载量及CD4细胞计数,对病毒未抑制的患者进行基因型耐药检测,采用生存分析方法分析耐药发生时间.结果 患者累计病死率为16%(12/75);共有66例发生耐药,累计耐药率为88%;生存分析发现,开始治疗的第1年,累计耐药率达到54.7%,患者不耐药的概率由100%下降到45.3%.半数患者保持对药物敏感的时间约为治疗后时间12.0个月(95%CI8.6～17.0);首次病毒载量≤4.0 lgU/ml和＞4.0 lgU/ml的两组患者,半数药物敏感的时间分别为25.1个月(95%CI19.0～33.3)和4.8个月(95%CI4.1～5.6).治疗过程中早发生耐药(12个月以内)的患者,病毒抑制失败和CD4细胞数下降的危险均较大.结论 耐药的发生随治疗时间上升,抗病毒治疗第1年发生耐药的危险最大,病毒载量高的患者耐药发生的速度快,发生耐药对治疗的效果影响显著.初期治疗取得最大的病毒抑制是控制耐药发生的关键.
目的 揭示在中國農村特殊的抗病毒治療模式下HIV-1耐藥髮生的規律.方法 2004年3月在中國河南某農村招募75例于2003年9月開始接受齊多伕定(AZT)+去羥肌苷(ddI)+奈韋拉平(NVP)治療的艾滋病患者,進行封閉式隊列研究,共隨訪12次、788人次、歷時6年3箇月,每次隨訪均檢測病毒載量及CD4細胞計數,對病毒未抑製的患者進行基因型耐藥檢測,採用生存分析方法分析耐藥髮生時間.結果 患者纍計病死率為16%(12/75);共有66例髮生耐藥,纍計耐藥率為88%;生存分析髮現,開始治療的第1年,纍計耐藥率達到54.7%,患者不耐藥的概率由100%下降到45.3%.半數患者保持對藥物敏感的時間約為治療後時間12.0箇月(95%CI8.6～17.0);首次病毒載量≤4.0 lgU/ml和＞4.0 lgU/ml的兩組患者,半數藥物敏感的時間分彆為25.1箇月(95%CI19.0～33.3)和4.8箇月(95%CI4.1～5.6).治療過程中早髮生耐藥(12箇月以內)的患者,病毒抑製失敗和CD4細胞數下降的危險均較大.結論 耐藥的髮生隨治療時間上升,抗病毒治療第1年髮生耐藥的危險最大,病毒載量高的患者耐藥髮生的速度快,髮生耐藥對治療的效果影響顯著.初期治療取得最大的病毒抑製是控製耐藥髮生的關鍵.
목적 게시재중국농촌특수적항병독치료모식하HIV-1내약발생적규률.방법 2004년3월재중국하남모농촌초모75례우2003년9월개시접수제다부정(AZT)+거간기감(ddI)+내위랍평(NVP)치료적애자병환자,진행봉폐식대렬연구,공수방12차、788인차、력시6년3개월,매차수방균검측병독재량급CD4세포계수,대병독미억제적환자진행기인형내약검측,채용생존분석방법분석내약발생시간.결과 환자루계병사솔위16%(12/75);공유66례발생내약,루계내약솔위88%;생존분석발현,개시치료적제1년,루계내약솔체도54.7%,환자불내약적개솔유100%하강도45.3%.반수환자보지대약물민감적시간약위치료후시간12.0개월(95%CI8.6～17.0);수차병독재량≤4.0 lgU/ml화＞4.0 lgU/ml적량조환자,반수약물민감적시간분별위25.1개월(95%CI19.0～33.3)화4.8개월(95%CI4.1～5.6).치료과정중조발생내약(12개월이내)적환자,병독억제실패화CD4세포수하강적위험균교대.결론 내약적발생수치료시간상승,항병독치료제1년발생내약적위험최대,병독재량고적환자내약발생적속도쾌,발생내약대치료적효과영향현저.초기치료취득최대적병독억제시공제내약발생적관건.
Objective To analyze the occurring rules of human immunodeficiency virus (HIV)drug resistance under an unique therapy model among HIV-1 infected individuals on antiretroviral therapy (ART) in rural areas of Henan, China. Methods A cohort of 75 individuals on an ART regimen of zidovudine (ZDV) , dideoxyinosine (ddI) and nevirapine (NVP) was established in March 2003. A total of 12 surveillances were conducted and 788 person-times were studied until 2010. The parameters of CD4 cell count and viral load (VL) were tested in each survey. And genotypic resistance testing was performed in patients with a failure of viral suppression. Survival analysis was used to estimate the occurrence time of resistance. Results The cumulative mortality rate was 16% (12/75) in the cohort. And the cumulative resistance rate was 88% (66/75) from 2004 to 2010. The rate of resistance reached 54. 7% and the probability from susceptibility to drugs developing resistance decreased drastically from 100% to 45. 3% within the first 1 year of initiation. The occurrence time of resistance for half of individuals in the cohort was at 12.0 months(95% CI 8. 6 - 17. 0)after initiation, 25. 1 months(95%C/19.0-33. 3)in those whose VL was less than 4. 0 lgU/ml and 4. 8 months (95% CI 4.1 - 5. 6) at VL ＞ 4. 0 lgU/ml during the first investigation. The individuals with an early occurrence of resistance within 12 months carried high risks for afailure of viral suppression and a decrease of CD4 counts. Conclusion The occurrence of resistance rises with the course of therapy. And the greatest probability for resistance is within the first 1 year of initial therapy. A high level of VL has a significant impact on the development of resistance. Preventing the occurrence of resistance during the initial therapy remains a key goal.
