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目的探讨抗结核治疗联合高效抗反转录病毒治疗(HAART)对AIDS合并结核病(AIDS/TB)患者HIV耐药性的影响。方法 101例AIDS患者(对照组)接受HAART,实验组126例AIDS/TB患者(实验组)抗结核治疗2~8周后开始HAART。监测两组患者的HIV病毒载量及CD4+T细胞计数,对HIV病毒载量大于1 000拷贝/ml的患者进行基因型耐药检测,比较两组耐药情况及HAART疗效。结果治疗24周时,实验组有7例患者病毒载量大于1 000拷贝/ml,其中1例检测出耐药突变基因,为蛋白酶(PR)基因检测次要耐药位点;对照组有1例病毒载量大于1 000拷贝/ml,但未检出HIV耐药突变基因。两组患者基因型耐药发生率差异无统计学意义(P>0.05)。两组患者治疗后CD4+T细胞计数均较治疗前上升,但两组组间治疗前后CD4+T细胞计数比较,差异均无统计学意义(P>0.05)。治疗48周时两组患者病毒载量均低于检测下限。结论 AIDS/TB双重感染者同时接受抗结核及HAART,未导致HIV耐药性的产生。
Objective To investigate the effect of anti-TB therapy combined with highly effective antiretroviral therapy (HAART) on HIV drug resistance in AIDS patients with tuberculosis (AIDS / TB). METHODS: A total of 101 AIDS patients (control group) received HAART, and 126 AIDS / TB patients (experimental group) started HAART 2 to 8 weeks after anti-TB treatment. HIV viral load and CD4 + T cell count were monitored in both groups. Genotypes were tested in patients with HIV viral load greater than 1 000 copies / ml. The drug resistance and the efficacy of HAART in both groups were compared. Results At 24 weeks of treatment, seven patients in the experimental group had a viral load greater than 1 000 copies / ml, of which 1 gene was detected as a drug resistant mutant and a minor resistance site for protease (PR) Cases of viral load greater than 1 000 copies / ml, but not detected HIV resistance mutations. There was no significant difference in the incidence of genotypic drug resistance between the two groups (P> 0.05). The CD4 + T cell counts in both groups increased after treatment, but there was no significant difference in CD4 + T cell count between the two groups before and after treatment (P> 0.05). After 48 weeks of treatment, viral load in both groups was lower than the detection limit. Conclusions Both HIV / TB and HIV / TB co-infected with anti-tuberculosis and HAART did not lead to HIV drug resistance.