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目的了解广西自治区患艾滋病(AIDS)儿童抗病毒治疗病毒学失败病例的耐药规律及特点。方法分析16例患AIDS儿童接受过高效抗反转录病毒治疗(HAART),并出现病毒学失败的临床及实验室资料,进行基因型耐药检测并对耐药突变结果进行分析。结果 16例患AIDS儿童的平均年龄(3.4±1.6)岁,平均治疗的时间为(13.2±5.5)个月,平均CD4T淋巴细胞百分比(11.08±7.05)%个,病毒载量的平均值(4.02±0.58)log10 IU/ml。在16例儿童中,基因型耐药检测结果为耐药的有15例,病毒学失败后耐药发生率为93.75%。在15例耐药的儿童中,7例(占46.67%)对非核苷类反转录酶抑制剂(NNRTI)的三种药物全部高度耐药,15例(占100%)对NVP耐药;10例(占66.67%)对DLV高度耐药,1例(占6.67%)为可能耐药;7例(46.67%)对EFV高度耐药,8例(占53.33%)为可能耐药。在15例耐药的儿童中,对核苷类反转录酶抑制剂(NRTI)的耐药突变结果显示:13例(占86.67%)对3TC和FTC高度耐药,1例对AZT高度耐药;1例对ddI高度耐药,1例为可能耐药;1例对d4T高度耐药,2例为可能耐药;1例对ABC高度耐药,2例为可能耐药;1例对TDF高度耐药,1例为可能耐药。结论 15例病毒学失败的艾滋病患儿,对正在使用的抗病毒药有不同程度耐药,需考虑更换新的抗病毒治疗方案。
Objective To understand the drug resistance and its characteristics in cases of failure of virus therapy in children with AIDS in Guangxi Autonomous Region. Methods Clinical and laboratory data of 16 AIDS patients who had received HAART and failed virological tests were analyzed for genotypic drug resistance and the results of drug resistance mutations were analyzed. Results The average age of 16 children with AIDS was (3.4 ± 1.6) years old, the average treatment time was (13.2 ± 5.5) months, the average percentage of CD4 T lymphocytes (11.08 ± 7.05)%, the mean value of viral load ± 0.58) log10 IU / ml. Among the 16 children, 15 were resistant to genotypic drug resistance and 93.75% were resistant to virologic failure. Of the 15 drug-resistant children, 7 (46.67%) were highly resistant to all three NNRTI drugs and 15 (100%) were resistant to NVP; 10 cases (66.67%) were highly resistant to DLV, 1 case (6.67%) were likely to be drug resistant, 7 cases (46.67%) were highly resistant to EFV and 8 cases (53.33%) were likely resistant. Among the 15 drug-resistant children, the resistance mutation to nucleoside reverse transcriptase inhibitor (NRTI) showed that 13 patients (86.67%) were highly resistant to 3TC and FTC and 1 patient highly resistant to AZT 1 case was highly resistant to ddI, 1 case was likely to be drug resistant; 1 case was highly resistant to d4T, 2 cases could be drug resistant; 1 case highly resistant to ABC and 2 cases likely to be drug resistant; 1 case to TDF highly resistant, 1 case may be resistant. Conclusion 15 cases of AIDS virus failure in children with anti-virus drugs being used to varying degrees of resistance, need to consider replacing the new anti-viral treatment program.