摘要
目的分析成年艾滋患者长期一线抗病毒治疗(cART)耐药发生情况,并探讨其可能的影响因素。方法在2007年8个省多阶段分层随机抽样横断面调查基础上建立封闭式队列,进行观察研究,以2009年调查时接受一线抗病毒治疗且病毒抑制成功的688例患者作为研究对象,在2010年对一线在治患者中病毒载量>1000拷贝/ml的样本采用ViroSeqM HIV-1基因型耐药检测试剂盒进行耐药检测。应用寿命表法校正公式计算耐药新发率,并以更换二线方案与否进行敏感度分析,在单因素分析基础上采用多因素Logistic回归探索影响耐药发生的因素。结果队列中688例2009年一线方案在治且病毒抑制成功的患者,在随后的12个月随访中10例死亡,8例更换为二线方案,其余670例坚持一线方案治疗的患者中有29例病毒载量超过1000拷贝/ml,扩增成功28例,其中22例患者对至少一种药物耐药,新发耐药率为(3.4～4.6)/100人年。22例耐药患者全部对非核苷反转录酶抑制剂(NNRTI)类药物耐药,16例对核苷类反转录酶抑制剂(NRTIs)类药物耐药,未发现对蛋白酶抑制剂(PI)类药物耐药或者同时对3TC和TDF耐药的患者。相对于在县级有以上机构治疗、从未发生过病毒学失败的患者,在乡村诊所治疗、既往发生过病毒学失败的患者发生耐药的风险分别提高6.5倍(95%CI:2.1～19.6)和5.3倍(95%CI:2.2～13.0)。结论调查地区长期一线抗病毒治疗的成年艾滋病患者,耐药发生率维持在较低水平;一线治疗失败的患者对于我国目前的二线治疗药物仍旧敏感;提高医疗服务水平、减少病毒学失败的发生有助于减少耐药的发生。
Objective To investigate the situation of drug resistance among HIV-infected patients receiving long term first-line combination antiretroviral treatment （cART） and to assess the interrelated risk factors. Methods A prospective cohort study was established in 8 provinces in China since 2007. Baseline information was collected in a cross-sectional survey through multi-stage random sampling. Totall of 688 HIV-infected patients who had received first-line cART and achieved virologic suppression in 2009 were enrolled into the cohort. HIV-infected patients with viral load higher than 1000 copies/ml in 2010 were detected by ViroSeqM HIV-1 genotyping system. Life table analysis was applied to calculate the incidence of drug resistance. A sensitivity analysis was applied to evaluate the effect of second-line regimens. Based on the bivariable results, the risk factors were included into the Multivariable Logistic Regression model. Results Total of 688 HIV-infected patients receiving cART and achieving virologic suppression were eligible to this study. Among those cases,10 cases died and 8 cases switched to second-line regimens after 12 months of follow-up. There were 29 cases with a viral load higher than 1000 copies/ml among whom, 22 patients were resistant to at least one antiretroviral drug based on genotypic assay. The incidence among drug resistance was （3.4-4.6）/100 person-years. All 22 patients were resistant to non-nucleoside reverse transcriptase inhibitor （NNRTI） and 16 patients were resistant to nucleoside reverse transcriptase inhibitor （NRTIs）. No case was resistant to protease inhibitor （PI） or the combination of 3TC and TDF. Compared with patients who received cART in county level clinics or above and treated successfully, those who received cART in the village level clinic （95%CI： 2.1-19.6） and experienced virologic treatment failure （95%CI： 2.2-13.0） were most likely to occur drug resistance. Conclusions The incidence of drug resistance remained low among HIV-infected patients receiving long term first-line cART. The patients experiencing first-line treatment failure were still sensitive to the second-line regimens. To decrease the drug resistance, it is ciricial to improve the quality of health care and to decline the virologic failure.
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2013年第2期29-34,共6页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
关键词
艾滋病
抗病毒治疗
耐药
Acquired immune deficiency syndrome （AIDS）
Antiretroviral treatment
Drug resistance
