摘要
目的分析山西省艾滋病(acquired immunodeficiency syndrome,AIDS)抗病毒治疗失败者HIV-1耐药检测结果及影响因素。方法收集2019—2020年HIV/AIDS患者抗病毒治疗满1年的治疗失败者血浆样品,进行耐药基因检测及基因亚型判定,并分析其影响因素。结果扩增成功率84.18%,总突变率59.29%,基因亚型以CRF01_AE为主。耐药基因突变发生的有统计学意义的相关因素为CD4+T淋巴细胞计数(简称CD4计数)(χ^(2)=18.01,P<0.001)、HIV-1基因亚型(χ^(2)=10.83,P=0.029)、治疗时间(月)(χ^(2)=6.24,P=0.044)。结果显示,核苷类逆转录酶抑制剂(nucleoside reverse transcriptase inhibitor,NRTI)/非核苷类逆转录酶抑制剂(non-nucleoside reverse transcriptase inhibitor,NNRTI)双重耐药占54.23%,NNRTI耐药占34.86%,蛋白酶抑制剂(protease inhibitor,PI)耐药占4.23%,NRTI耐药占2.82%,PI/NNRTI双重耐药占2.46%,PI/NRTI/NNRTI三重耐药占1.41%。NNRTI耐药突变位点主要为K103N、Y181C、G190A;NRTI耐药突变位点主要为M184V、K65R、K70R;PI耐药突变位点主要为M46L、Q58E。发生NNRTI耐药者,对奈韦拉平(nevirapine,NVP)高度耐药最多占76.76%;发生NRTI耐药者中,对恩曲他滨(emtricitabine,FTC)/拉米夫定(lamivudine,3TC)高度耐药最多占46.83%;未发现对PI高度耐药。结论CD4计数低、治疗时间较长、BC亚型和CRF01_AE亚型毒株者在山西省HIV/AIDS患者中发生耐药突变比例较高,位点多以多基因编码区突变混合存在,对FTC/3TC、NVP产生高度耐药者较多。
Objective To analyze the HIV-1 drug resistance and related influencing factors of HIV antiviral therapy failures.Methods Plasma samples were collected from the HIV/AIDS patients who had failed after antiviral therapy for one year at least from 2019 to 2020 for drug resistance gene detection and gene subtype determination,and the influencing factors were analyzed.Results Among 479 successful samples,284 had drug resistance gene mutation,the success rate of amplification was 84.18%,the mutation rate was 59.29%,the main gene subtype was CRF01_AE.The related factors of drug resistance gene mutation are CD4+T lymphocyte count(CD4 count)(χ^(2)=18.01,P<0.001),HIV-1 subtype(χ^(2)=10.83,P=0.029)and treatment duration(month)(χ^(2)=6.24,P=0.044)during drug resistance test.Nucleoside reverse transcriptase inhibitor(NRTI)/non-nucleoside reverse transcriptase inhibitor(NNRTI)double resistance accounted for 54.23%,NNRTI drug resistance accounted for 34.86%,protease inhibitor(PI)drug resistance accounted for 4.23%,NRTI drug resistance accounted for 2.82%,PI/NNRTI double drug resistance accounted for 2.46%,PI/NRTI/NNRTI triple drug resistance accounted for 1.41%.NNRTI mutation mainly occurred at K103N,Y181C,G190A sites.NRTI mutation mainly occurred at M184V,K65R,K70R sites.PI mutation mainly occurred at M46L and Q58E sites.High resistance to nevirapine(NVP)accounted for up to 76.76%of patients with NNRTI resistance.Among the patients with NRTI resistance,46.83%were highly resistant to emtricitabine(FTC)/lamivudine(3TC).There was no high resistance to PI among 284 drug resistant patients.Conclusions Patients with low CD4 count,longer treatment time,BC subtype and CRF01_AE subtype had a higher incidence of drug resistance mutations in HIV/AIDS patients in Shanxi province.Most of them are mixed with multi-gene coding region mutations and have high resistance to FTC/3TC and NVP.
作者
郭晓黎
张飞
刘萧湘
焦晋
聂晓勇
Guo Xiaoli;Zhang Fei;Liu Xiaoxiang;Jiao Jin;Nie Xiaoyong(Shanxi Provincial Center for Disease Control and Prevention,Taiyuan 030012,China)
出处
《中华实验和临床病毒学杂志》
CAS
CSCD
2022年第2期176-182,共7页
Chinese Journal of Experimental and Clinical Virology
