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目的了解河南省某地人类免疫缺陷病毒(HIV)耐药性毒株的进化演变规律。方法将河南省南部某地74例接受齐多夫定(AZT)+去羟肌苷(ddI)+奈韦拉平(NVP)联合抗病毒治疗的艾滋病患者纳入研究队列,分别在抗病毒治疗后3、6、12、18个月进行随访调查,通过逐一访谈了解一般情况、服药方案、服药依从性及保障措施、抗病毒治疗前后的临床表现等,同时采集14 ml EDTA抗凝静脉血,检测CD4/CD8细胞数、病毒载量及基因型耐药性。结果核苷类反转录酶抑制剂中,发生频率最高的耐药突变位点是:67、118、151和215。治疗3、6、12、18个月时AZT耐药发生率分别为6．76％、13．51％、14．86％和9．46％,ddI的耐药发生率分别为2．70％、6．76％、8．11％和5．45％,AZT的耐药发生率高于ddI,核苷类反转录酶抑制剂的耐药性呈现出先上升后下降的趋势。非核苷类反转录酶抑制剂的耐药发生率高于核苷类反转录酶抑制刺,发生频率最高的耐药突变位点是:103和181。治疗3、6、12、18个月时,NVP耐药发生率分别为9．46％、18．92％、22．97％和32．43％。非核苷类反转录酶抑制刺呈现出持续上升的耐药发生趋势。耐药和不耐药患者的病毒载量和CD4~+T淋巴细胞计数无显著性差异。服药依从性差可能是耐药发生的主要影响因素。结论本组患者中已出现对非核苷类反转录酶抑制剂的高度耐药,服药依从性是耐药发生的主要影响因素。应加强服药的监督管理,改善患者的服药依从性。
Objective To understand the evolution and evolution of human immunodeficiency virus (HIV) resistant strains in Henan Province. Methods A total of 74 AIDS patients treated with azithromycin (AZT) + didanosine (ddI) plus nevirapine (NVP) combined with antiviral therapy were enrolled in the study cohort in a southern Henan province. , 12,18 months follow-up survey, through an interview to understand the general situation, medication programs, medication compliance and safeguards, before and after antiviral therapy clinical manifestations, etc., while collecting 14 ml EDTA anticoagulated venous blood, CD4 / CD8 Cell number, viral load and genotype resistance. Results Nucleotide reverse transcriptase inhibitors, the highest frequency of drug-resistant mutations: 67,118,151,215. The rates of AZT resistance at 3, 6, 12 and 18 months were 6.76%, 13.51%, 14.86% and 9.46%, respectively, and the rates of resistance to ddI were 2.70% , 6.76%, 8.11% and 5.45% respectively. The resistance rate of AZT was higher than that of ddI. The resistance of nucleoside reverse transcriptase inhibitors showed a trend of first increasing and then decreasing. The non-nucleoside reverse transcriptase inhibitor drug resistance rate is higher than the nucleoside reverse transcriptase inhibition thorns, the highest frequency of drug-resistant mutation sites: 103 and 181. At 3, 6, 12 and 18 months, the incidences of NVP resistance were 9.46%, 18.92%, 22.97% and 32.43%, respectively. Non-nucleoside reverse transcriptase inhibition of thorns showed a rising trend of drug resistance. There was no significant difference in viral load and CD4 ~ + T lymphocyte count between drug resistant and drug resistant patients. Poor medication compliance may be the main influencing factor of drug resistance. Conclusion This group of patients has been highly non-nucleoside reverse transcriptase inhibitor resistance, medication adherence is the main influencing factor of drug resistance. Should strengthen the supervision and administration of medication to improve the patient’s medication compliance.