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目的分析吉林、黑龙江、河南、陕西、辽宁、内蒙古、云南7省人类免疫缺陷病毒(HIV)感染者耐药变异情况及其影响因素。方法2005年5月至9月将中国医科大学附属第一医院艾滋病研究所问卷调查的718例HIV感染者治疗和漏服情况,RT-PCR和套式PCR扩增HIVpol区基因,逆转录酶和蛋白酶基因序列,与国际HIV耐药数据库比对辨别耐药变异。结果治疗组HIV抑制情况显著好于未治疗感染者(P<0.01),但其耐药变异高于未治疗组(P<0.05);抗病毒治疗6个月以内组耐药突变率显著低于6个月以上组(P<0.01);依从性好的患者HIV耐药突变率明显低于依从性差的患者(P<0.05),HIV抑制情况明显优于依从性差的患者(P<0.05);D4T/3TC/NVP方案HIV抑制效果明显优于其他方案(P<0.01),HIV耐药突变率也较低(P<0.05)。结论随着抗病毒治疗时间延长,耐药突变率显著增高,服药依从性与耐药突变显著相关。一线治疗方案首选D4T/3TC/NVP。
Objective To analyze the resistance variation and its influencing factors of human immunodeficiency virus (HIV) infection in Jilin, Heilongjiang, Henan, Shaanxi, Liaoning, Inner Mongolia and Yunnan provinces. Methods From May to September 2005, 718 HIV-infected and untreated HIV-infected patients were surveyed by the AIDS Institute of the First Affiliated Hospital of China Medical University. RT-PCR and nested PCR were used to amplify HIVpol gene, reverse transcriptase Protease gene sequences, and international HIV resistance database comparison to identify resistance mutations. Results The HIV suppression in the treatment group was significantly better than that in the untreated group (P <0.01), but the resistance mutation was higher in the treatment group than in the untreated group (P <0.05). The mutation resistance rate in the anti-virus treatment group within 6 months was significantly lower than that in the untreated group (P <0.01). The mutation rate of HIV resistance in patients with good compliance was significantly lower than that in patients with poor compliance (P <0.05), and the HIV suppression was significantly better than those with poor compliance (P <0.05). The D4T / 3TC / NVP regimen showed significantly better HIV inhibition than other regimens (P <0.01), and the rate of HIV resistance mutation was also lower (P <0.05). Conclusion With the prolongation of antiviral therapy, the rate of drug-resistant mutation was significantly increased, and the compliance of drug-taking was significantly correlated with drug-resistant mutation. First-line treatment options preferred D4T / 3TC / NVP.