论文部分内容阅读
目的了解成都、绵阳、达州、乐山和宜宾HIV/AIDS在治患者治疗效果和耐药性影响因素。方法 2014年对以上地区抗病毒治疗半年以上,年龄≥15岁的HIV/AIDS患者进行血浆HIV病毒载量(VL)及基因型耐药检测,采用统计学卡方检验及logistic回归分析治疗效果及病毒抑制失败患者耐药发生的影响因素,以及各亚型毒株间耐药突变规律。结果 4 087例符合调查标准,其中VL<400拷贝/ml 3534例(86.47%),VL>1 000拷贝/ml 510例(12.48%)。多因素logistic回归分析发现患者所在地区、年龄、传播途径及治疗时间对治疗效果的影响有统计学意义。VL>1 000拷贝/ml患者样本中,389例(76.27%)核酸扩增阳性并获得基因序列,189例(48.59%)发生耐药突变,主要导致核苷类逆转录酶抑制剂和非核苷类逆转录酶抑制剂耐药,多因素logistic回归分析初始治疗方案、治疗前CD4水平及感染CRF_01AE亚型毒株对耐药发生率的影响有统计学意义。耐药突变序列中,部分位点耐药突变率在CRF_01AE和CRF_07BC两种亚型毒株间差异具有统计学意义。结论四川省成都、绵阳、达州、乐山和宜宾地区HIV/AIDS患者中,地区、年龄、传播途径及治疗时间是治疗效果的影响因素;病毒抑制失败患者中,初始治疗方案、基线CD4水平及感染不同亚型毒株是耐药的因素影响;CRF_01AE和CRF_07BC亚型毒株比较,前者更易发生T69、M184、V75、Y181突变,而后者更易发生Q58、A71突变。
Objective To investigate the treatment effect and drug resistance of HIV / AIDS patients in Chengdu, Mianyang, Dazhou, Leshan and Yibin. Methods In 2014, HIV viral load (VL) and genotypic drug resistance of HIV / AIDS patients aged more than six months and over 15 years of age were measured. Statistical analysis was conducted using logistic regression analysis and Chi-square test. Influencing factors of drug resistance in patients with failed virus suppression, and the rule of drug-resistance mutation in each subtype of virus. Results A total of 4 087 cases met the survey criteria, including 3534 cases (86.47%) with VL <400 copies / ml and 510 cases (12.48%) with VL> 1 000 copies / ml. Multivariate logistic regression analysis found that the location of the patient, age, route of transmission and treatment time on the treatment effect was statistically significant. 389 (76.27%) of the patients with VL> 1 000 copies / ml had positive nucleic acid amplification and obtained the gene sequence, and 189 (48.59%) had drug-resistant mutations, which led to nucleoside reverse transcriptase inhibitors and non-nucleoside Reversal of drug resistance, multivariate logistic regression analysis of initial treatment regimen, CD4 level before infection and infection of CRF_01AE subtypes had a significant effect on drug resistance rate. In the resistant mutation sequence, the mutation rate of some sites was statistically different between the two subtypes CRF_01AE and CRF_07BC. Conclusion Among the HIV / AIDS patients in Chengdu, Mianyang, Dazhou, Leshan and Yibin areas in Sichuan Province, regional, age, route of transmission and duration of treatment are the influencing factors for treatment outcome. Initial treatment regimen, baseline CD4 level and infection Different subtypes of strains are resistant to the factor of drug resistance. Compared with subtype CRF_01AE and CRF_07BC, the former is more likely to have T69, M184, V75 and Y181 mutations, while the latter is more susceptible to Q58 and A71 mutations.