CAJ | 학술논문

目的了解云南省德宏州艾滋病患者接受抗病毒治疗后HIV病毒抑制率及耐药突变情况.方法对德宏州截止2012年12月31日入组、抗病毒治疗半年以上、年龄≥15岁的全部在治患者进行血浆HIV病毒载量(VL)检测及耐药相关基因位点突变监测.结果符合入选标准的病例共4 390例,其中3 964例(90.3％)参加了本研究,2 307例(58.2％)研究对象CD4+T淋巴细胞计数在350 cells/mm3以上.3 169例(79.9％)研究对象血浆VL低于检测下限.其中,瑞丽市、女性、年龄在45岁以上、已婚、异性传播、治疗时间＞5年、CD4+T淋巴细胞计数＞500 cells/mm3的患者中血浆VL低于检测下限者所占比例显著高于其他患者,差异有统计学意义.402例(10.1％)患者血浆VL≥1 000 copy/ml,其中353例(87.8％)成功进行了耐药相关基因位点突变检测,并有198例(56.1％)检测发现耐药基因突变,以核苷类反转录酶抑制剂(NRTIs)和非核苷类反转录酶抑制剂(NNRTIs)耐药为主,分别以M184V和K103N突变最为常见.有12例(3.4％)患者存在蛋白酶抑制剂(PI)耐药基因突变.多因素logistic回归分析显示:治疗时间及初始治疗药物组合对耐药发生率的影响有统计学意义.结论云南省德宏州艾滋病患者接受抗病毒治疗后,HIV抑制率较高,但在病毒抑制效果不好的患者中耐药比例较高,需继续加强抗病毒治疗依从性教育,并及时做好血浆VL检测及耐药监测工作.
목적 료해운남성덕굉주애자병환자접수항병독치료후HIV병독억제솔급내약돌변정황.방법 대덕굉주절지2012년12월31일입조、항병독치료반년이상、년령≥15세적전부재치환자진행혈장HIV병독재량(VL)검측급내약상관기인위점돌변감측.결과 부합입선표준적병례공4 390례,기중3 964례(90.3％)삼가료본연구,2 307례(58.2％)연구대상CD4+T림파세포계수재350 cells/mm3이상.3 169례(79.9％)연구대상혈장VL저우검측하한.기중,서려시、녀성、년령재45세이상、이혼、이성전파、치료시간＞5년、CD4+T림파세포계수＞500 cells/mm3적환자중혈장VL저우검측하한자소점비례현저고우기타환자,차이유통계학의의.402례(10.1％)환자혈장VL≥1 000 copy/ml,기중353례(87.8％)성공진행료내약상관기인위점돌변검측,병유198례(56.1％)검측발현내약기인돌변,이핵감류반전록매억제제(NRTIs)화비핵감류반전록매억제제(NNRTIs)내약위주,분별이M184V화K103N돌변최위상견.유12례(3.4％)환자존재단백매억제제(PI)내약기인돌변.다인소logistic회귀분석현시:치료시간급초시치료약물조합대내약발생솔적영향유통계학의의.결론 운남성덕굉주애자병환자접수항병독치료후,HIV억제솔교고,단재병독억제효과불호적환자중내약비례교고,수계속가강항병독치료의종성교육,병급시주호혈장VL검측급내약감측공작.
Objective To understand HIV rival suppression and drug resistance (HIVDR) among AIDS patients who were receiving antiretroviral treatment (ART) in Dehong prefecture,Yunnan province.Methods All AIDS patients who were aged over 15 years and with experience more than six months on ART by the end of 2012 in Dehong prefecture,were enrolled to receive testing for HIV viral load in plasma and genetic mutations associated with HIVDR.Results A total of 4 390 AIDS patients were qualified for the study according to the selection criteria,of whom 3 964 (90.3％) finally participated in the study.Among them,2 307 (58.2％) had CD4+ cell counts more than 350 cells/mm3.3 169 (79.9％) patients showed undetectable plasma HIV viral load which was lower than the detection threshold.Those who had the following factors as:resided in Ruili city,being female,older than 45 years of age,married,heterosexually infected with HIV,having received ART more than 5 years,and CD4 + cell counts ＞500 cells/mm3,were more likely to have undetectable plasma virus load,with the differences statistically significant.402 (10.1％) patients had plasma viral load ≥1 000 copies/ml,of whom 353 (87.8％) were successfully amplified and examined for HIVDR.Among them,198 (56.1％) were identified to bear genetic mutations associated with HIVDR.Most mutations were related to the resistance to nucleotide reverse transcriptase inhibitors (NNRTIs) or non-nucleotide reverse transcriptase inhibitors (NNRTIs),with M184V and K103N most frequently seen.12 patients (3.4％) were found to have mutations resistant to protease inhibitors (PI).Data from multiple logistic regression analysis indicated that the period of receiving ART and the initial ART regimen could both significantly predict the occurrence of HIV resistance.Conclusion Viral suppression was highly achieved among ART-prescribed AIDS patients in Dehong prefecture,Yunnan province.However,among those who did not show effective viral suppression,the proportion of HIVDR was high,underscoring the needs for health education so as to improve the adherence to drugs as well as for improving testing for viral load and HIVDR among AIDS patients.