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目的了解云南省德宏州艾滋病患者抗病毒治疗后艾滋病病毒(human immunodeficiency virus,HIV)耐药发生率及其影响因素。方法根据WHO推荐的HIV耐药警戒线调查方法,于2009年、2010年对德宏州陇川县参加抗病毒治疗的250例艾滋病患者进行HIV耐药基因突变检测研究。结果 250例患者在2009年的监测中有11名患者出现耐药,人群总耐药率为4.4%。2009年检测没有发生耐药而2010年参加随访调查的221名患者中新发生了7例耐药,新发HIV耐药率3.2%。所有发生耐药的患者均对非核苷类逆转录酶抑制剂(non-nucleotidereverse transcriptase inhibitors,NNRTI)耐药,但没有患者对蛋白酶抑制剂(protease inhibitors,PI)耐药。2009年和2010年两年监测血浆HIV病毒载量(viral load,VL)≥1 000拷贝/ml的患者中发生耐药的比例分别为55.0%(11/20)和84.6%(11/13)。单因素COX回归分析显示,最近1个月有饮酒史的患者HIV耐药发生率高于无饮酒史者,但多因素COX回归分析未显示两者间存在关联。此外,对两次调查中VL≥1 000拷贝/ml的全部28名患者进行HIV病毒亚型测定,共发现5个HIV病毒亚型,其中C亚型10例(35.7%)、B亚型10例(35.7%)、CRF08_BC 4例(14.3%)、CRF01_AE 3例(10.7%)、CRF29_BF 1例(3.6%)。结论德宏州接受抗病毒治疗、血浆HIV病毒载量在1 000拷贝/ml以上的艾滋病患者中HIV耐药率高,HIV耐药发生可能与患者饮酒习惯有关。
Objective To investigate the incidence of HIV-1 and its influencing factors in HIV-infected patients after devastating HIV infection in Dehong Prefecture of Yunnan Province. Methods A total of 250 AIDS patients who participated in antiviral therapy in Longchuan County, Dehong Prefecture in 2009 and 2010 were investigated for the HIV resistance gene mutation according to the WHO recommended HIV resistance warning line survey method. Results Of the 250 patients in 2009 surveillance, 11 patients were resistant, with a total population resistance rate of 4.4%. In 2009, no resistance was detected in the test. Of the 221 patients who participated in the follow-up survey in 2010, 7 new drug-resistant cases were reported, and the newly-emerged HIV drug resistance rate was 3.2%. All resistant patients were resistant to non-nucleotide reverse transcriptase inhibitors (NNRTIs), but no patients were resistant to protease inhibitors (PIs). The rates of resistance in 55% (11/20) and 84.6% (11/13) of the patients with ≥ 1000 copies / ml of viral load (VL) monitored in 2009 and 2010, respectively, . Univariate Cox regression analysis showed that the incidence of HIV drug resistance was higher in patients who had had a history of drinking in the recent 1 month than in those without alcoholism, but multivariate COX regression analysis did not show any association between them. In addition, HIV virus subtypes were determined in all 28 patients with VL ≥1 000 copies / ml in two surveys. Five HIV virus subtypes were found, of which 10 (35.7%) were in subtype C and 10 (35.7%), 4 cases (14.3%) of CRF08_BC, 3 cases (10.7%) of CRF01_AE and 1 case (3.6%) of CRF29_BF. Conclusions In HIV / AIDS patients treated with anti-virus therapy in Dehong prefecture, the HIV rate of HIV infection is higher than 1 000 copies / ml, and the development of HIV resistance may be related to the drinking habits of patients.