中华流行病学杂志
中華流行病學雜誌
중화류행병학잡지
CHINESE JOURNAL OF EPIDEMIOLOGY
2011年
11期
1082-1086
,共5页
王启兴%王霞%陈彬%马志凌%梁姝%廖玲洁%马名驹%卫大英%秦光明%阮玉华%邵一鸣%邢辉
王啟興%王霞%陳彬%馬誌凌%樑姝%廖玲潔%馬名駒%衛大英%秦光明%阮玉華%邵一鳴%邢輝
왕계흥%왕하%진빈%마지릉%량주%료령길%마명구%위대영%진광명%원옥화%소일명%형휘
艾滋病毒%抗病毒治疗%静脉吸毒者%耐药
艾滋病毒%抗病毒治療%靜脈吸毒者%耐藥
애자병독%항병독치료%정맥흡독자%내약
Human immunodeficiency virus%Anti-virus treatment%Injecting drug user%Drug resistance
目的 了解四川省凉山州HIV耐药株的流行现况和相关影响因素.方法 于2010年8-10月,采用横断面调查方法收集凉山州7个县(市)317名接受抗病毒治疗艾滋病患者的流行病学资料和治疗数据,同时采集血样进行CD4+T淋巴细胞、病毒载量(VL)和耐药基因型突变检测.结果 调查对象VL＜ 1000 copy/ml的比例为73.50％ (233/317)；CD4+T淋巴细胞数中位数(M)为329 cell/μl,总耐药率为8.20％ (26/317).84名病毒抑制失败的患者中,总耐药率为30.95％(26/84).对非核苷类反转录酶抑制剂耐药率为28.57％ (24/84)、对核苷类反转录酶抑制剂耐药率为8.33％(7/84)、对蛋白酶类药物耐药率为1.19％(1/84).多因素分析显示,影响耐药发生的因素有通过静脉吸毒感染(AOR=3.37,95％CI:1.06～ 10.66,P=0.0390)、调查前无原因的慢性腹泻＞1个月(AOR=8.38,95％CI:1.87 ～ 37.69,P＝0.0055)、CD4+T淋巴细胞数＜200 cell/μl (AOR＝3.48,95％CI:1.29～ 9.39,P=0.0139)和来自布拖县(AOR=17.68,95％CI:4.97～ 62.86,P＜0.0001).22名耐药的患者85.00％集中在布拖县,通过布拖县与其他地区的比较,发现民族为彝族(AOR=17.35,95％ CI:2.01 ～ 149.73,P＝0.0095)、文化程度为小学及以上(AOR=0.18,95％ CI:0.08 ～0.42,P＜0.0001)、婚姻状况为已婚或同居(AOR=8.17,95％CI:2.35～ 28.39,P=0.001)、近1个月按要求按时按量服用抗病毒药的比例≥90.00％ (AOR =0.05,95％ CI:0.02～0.13,P＜0.0001)与耐药的产生有相关性.结论 凉山地区艾滋病抗病毒治疗获得较好效果.不同地区耐药率差异较大.需要重视静脉吸毒人群耐药预防,并强化依从性教育和监督.
目的 瞭解四川省涼山州HIV耐藥株的流行現況和相關影響因素.方法 于2010年8-10月,採用橫斷麵調查方法收集涼山州7箇縣(市)317名接受抗病毒治療艾滋病患者的流行病學資料和治療數據,同時採集血樣進行CD4+T淋巴細胞、病毒載量(VL)和耐藥基因型突變檢測.結果 調查對象VL＜ 1000 copy/ml的比例為73.50％ (233/317)；CD4+T淋巴細胞數中位數(M)為329 cell/μl,總耐藥率為8.20％ (26/317).84名病毒抑製失敗的患者中,總耐藥率為30.95％(26/84).對非覈苷類反轉錄酶抑製劑耐藥率為28.57％ (24/84)、對覈苷類反轉錄酶抑製劑耐藥率為8.33％(7/84)、對蛋白酶類藥物耐藥率為1.19％(1/84).多因素分析顯示,影響耐藥髮生的因素有通過靜脈吸毒感染(AOR=3.37,95％CI:1.06～ 10.66,P=0.0390)、調查前無原因的慢性腹瀉＞1箇月(AOR=8.38,95％CI:1.87 ～ 37.69,P＝0.0055)、CD4+T淋巴細胞數＜200 cell/μl (AOR＝3.48,95％CI:1.29～ 9.39,P=0.0139)和來自佈拖縣(AOR=17.68,95％CI:4.97～ 62.86,P＜0.0001).22名耐藥的患者85.00％集中在佈拖縣,通過佈拖縣與其他地區的比較,髮現民族為彝族(AOR=17.35,95％ CI:2.01 ～ 149.73,P＝0.0095)、文化程度為小學及以上(AOR=0.18,95％ CI:0.08 ～0.42,P＜0.0001)、婚姻狀況為已婚或同居(AOR=8.17,95％CI:2.35～ 28.39,P=0.001)、近1箇月按要求按時按量服用抗病毒藥的比例≥90.00％ (AOR =0.05,95％ CI:0.02～0.13,P＜0.0001)與耐藥的產生有相關性.結論 涼山地區艾滋病抗病毒治療穫得較好效果.不同地區耐藥率差異較大.需要重視靜脈吸毒人群耐藥預防,併彊化依從性教育和鑑督.
목적 료해사천성량산주HIV내약주적류행현황화상관영향인소.방법 우2010년8-10월,채용횡단면조사방법수집량산주7개현(시)317명접수항병독치료애자병환자적류행병학자료화치료수거,동시채집혈양진행CD4+T림파세포、병독재량(VL)화내약기인형돌변검측.결과 조사대상VL＜ 1000 copy/ml적비례위73.50％ (233/317)；CD4+T림파세포수중위수(M)위329 cell/μl,총내약솔위8.20％ (26/317).84명병독억제실패적환자중,총내약솔위30.95％(26/84).대비핵감류반전록매억제제내약솔위28.57％ (24/84)、대핵감류반전록매억제제내약솔위8.33％(7/84)、대단백매류약물내약솔위1.19％(1/84).다인소분석현시,영향내약발생적인소유통과정맥흡독감염(AOR=3.37,95％CI:1.06～ 10.66,P=0.0390)、조사전무원인적만성복사＞1개월(AOR=8.38,95％CI:1.87 ～ 37.69,P＝0.0055)、CD4+T림파세포수＜200 cell/μl (AOR＝3.48,95％CI:1.29～ 9.39,P=0.0139)화래자포타현(AOR=17.68,95％CI:4.97～ 62.86,P＜0.0001).22명내약적환자85.00％집중재포타현,통과포타현여기타지구적비교,발현민족위이족(AOR=17.35,95％ CI:2.01 ～ 149.73,P＝0.0095)、문화정도위소학급이상(AOR=0.18,95％ CI:0.08 ～0.42,P＜0.0001)、혼인상황위이혼혹동거(AOR=8.17,95％CI:2.35～ 28.39,P=0.001)、근1개월안요구안시안량복용항병독약적비례≥90.00％ (AOR =0.05,95％ CI:0.02～0.13,P＜0.0001)여내약적산생유상관성.결론 량산지구애자병항병독치료획득교호효과.불동지구내약솔차이교대.수요중시정맥흡독인군내약예방,병강화의종성교육화감독.
Objective To investigate the HIV drug resistance among HIV/AIDS patients who had received highly active antiretroviral treatment (HAATR) in Liangshan prefecture and related factors.Methods This investigation was conducted from August to October 2010.Data on epidemiology,treatment,CD4 + T cell,viral load and drug resistance tests were collected.Results 233 (73.50％) had a viral load of ＜ 1000 copy/ml,with the median CD4+T cell count as 329 cell/μl.26 samples appeared to be drug resistant,with the rate as 8.20％.Among 84 patients with antiviral therapy failure,the overall drug resistance rate was 30.95％(26/84).While 24 (28.57％) were resistant to non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs.Among nucleoside reverse transcriptase inhibitors (NRTI),7 (8.33％) were resistant.1 (1.19％) had protease inhibitor (PI)resistance mutations identified.Factors that significantly associated with drug resistance would include:being injecting drug users (A OR =3.37,95 ％ CI:1.06-10.66,P =0.0390),having had chronic diarrhea ＞1 month (AOR=8.38,95％ CI:1.87-37.69,P=0.0055),having had CD4+T cell＜200(AOR=3.48,95％CI:1.29-9.39,P=0.0139),being residents from Butuo area (AOR=17.68,95％ CI:4.97-62.86,P＜0.0001 ).When comparing with other areas,data from Butuo showed that people who carried Yi ethnicity (AOR=17.35,95％ CI:2.01-149.73,P=0.0095) and were literate (having had primary or higher levels of education) (AOR=0.18,95％ CI:0.08-0.42,P＜0.0001 ),being married or having cohabited relations (AOR=8.17,95％ CI:2.35-28.39,P=0.001 ) were found to be less adherent (AOR=0.05,95％ CI:0.02-0.13,P＜0.0001) to the treatment.Conclusion Successful antiviral outcomes were seen among those AIDS patients under treatment,in Liangshan prefecture.Resistance rates were significantly different in regions.For IDUs,enforcement on subjects including prevention on drug resistance,adherence to HAART and treatment for drug addiction should be strengthened and programs being integrated.
