CAJ | 학술논문

目的阐明河南省长期接受艾滋病抗病毒治疗患者的耐药情况,为这类患者继续有效的治疗提供参考依据.方法抽取河南省两个艾滋病重点县中2004年左右开始接受一线抗病毒治疗的艾滋病患者,进行CD4+T淋巴细胞、病毒载量和基因型耐药检测.结果两个县共抽取164例艾滋病患者,这些患者的CD4+T淋巴细胞计数的中位数(四分位数)为398.00(242.00 ～489.50)个/μl,有32.32％的患者体内检测不到病毒.有95例患者的病毒载量大于1000拷贝/ml,其中的77例患者完成了耐药检测.在这77例患者中,有耐药突变(任意一种)发生的患者占到68.83％,其中NNRTIs类突变较高为64.94％,NRTIs类突变为55.84％,无PIs类突变发生.NNRTIs类耐药突变中发生最多的是K103N/S(44.16％),其次为G190A/S(19.48％)和Y181C/V(14.29％).NRTIs类耐药突变中发生最多的是胸苷类似物突变(thymidine analogue mutations,TAMs),≥1TAM占46.75％,TAM-1/TAM-2占24.68％,M184V/I为24.68％.77例患者中,对NRTIs类药物ddI、3TC、AZT、D4T和TDF产生耐药的患者分别占50.65％、33.77％、48.05％、50.65％和46.75％.对NNRTIs类药物EFV、NVP和DLV产生耐药的患者分别占64.94％、64.94％和62.34％.结论河南省长期接受抗病毒治疗的艾滋病患者的耐药情况严峻,需要对这部分患者重点关注并及时调整治疗方案.
목적 천명하남성장기접수애자병항병독치료환자적내약정황,위저류환자계속유효적치료제공삼고의거.방법 추취하남성량개애자병중점현중2004년좌우개시접수일선항병독치료적애자병환자,진행CD4+T림파세포、병독재량화기인형내약검측.결과 량개현공추취164례애자병환자,저사환자적CD4+T림파세포계수적중위수(사분위수)위398.00(242.00 ～489.50)개/μl,유32.32％적환자체내검측불도병독.유95례환자적병독재량대우1000고패/ml,기중적77례환자완성료내약검측.재저77례환자중,유내약돌변(임의일충)발생적환자점도68.83％,기중NNRTIs류돌변교고위64.94％,NRTIs류돌변위55.84％,무PIs류돌변발생.NNRTIs류내약돌변중발생최다적시K103N/S(44.16％),기차위G190A/S(19.48％)화Y181C/V(14.29％).NRTIs류내약돌변중발생최다적시흉감유사물돌변(thymidine analogue mutations,TAMs),≥1TAM점46.75％,TAM-1/TAM-2점24.68％,M184V/I위24.68％.77례환자중,대NRTIs류약물ddI、3TC、AZT、D4T화TDF산생내약적환자분별점50.65％、33.77％、48.05％、50.65％화46.75％.대NNRTIs류약물EFV、NVP화DLV산생내약적환자분별점64.94％、64.94％화62.34％.결론 하남성장기접수항병독치료적애자병환자적내약정황엄준,수요대저부분환자중점관주병급시조정치료방안.
Objective To elucidate the condition of drug resistance among acquired immune deficiency syndrome (AIDS) patients with a long-term antiretroviral treatment in Henan province,provide some useful data for such patients to continue effective treatment.Method Patients beginning first-line antiretroviral treatment before and after 2004 were selected in two counties of Henan.CD4+ T cells,virus load and genotypic resistance(In-house) were tested.Results A total of 164 patients were selected in two counties,with a median (interquartile range,IQR) CD4+T cells 398.00 (242.00-489.50 )cells/μl,32.32％ of the patients had a virus load lower than the lowest detected level.Ninety-five patients had a virus load more than 1000 copies/ml,77 of them completed the drug resistance test,drug resistance mutations occurred in 68.83％,the NNRTIs and NRTIs mutations were found in 64.94％ and 55.84％ of them,respectively,no PIs mutations were detected. K103N/S (44.16％) was the most frequent NNRTIs mutations that have occurred,followed by G190A/S (19.48％) and Y181C/V (14.29％ ).Thymidine analogue mutations (TAMs) was the most common NRTIs mutations that have occurred,≥1TAM accounted for 46.75％,TAM-1/TAM-2 accounted for 24.68％.M184V/I was also the NRTIs mutations.Among the 77 patients,the proportion of patients who had resistance to the NRTIs:ddI,3TC,AZT,D4T and TDF was 50.65％,33.77％,48.05％,50.65％ and 46.75％ respectively,the proportion of patients who had resistance to the NNRTIs:EFV,NVP and DLV was 64.94％,64.94％ and 62.34％,respectively.Conclusion The situation of drug resistance among AIDS patients treated with a long-term antiretroviral treatment in Henan province was serious,more attention and timely treatment adjustment are needed to such patients with AIDS.