不同时期抗病毒治疗对艾滋病患者耐药产生的影响分析

doi:10.6040/j.issn.1671-7554.0.2016.005

摘要/Abstract

摘要： 目的比较不同时机开始抗病毒治疗对艾滋病患者耐药产生的影响。方法对河南省接受一线抗病毒治疗方案>6个月的艾滋病患者进行横断面调查,根据基线免疫水平,将调查对象分为早期治疗组(CD4⁺T淋巴细胞≥350个/mm³)132例、常规治疗组(CD4⁺T淋巴细胞201个/mm³~349个/mm³)200例和延迟治疗组(CD4⁺T淋巴细胞≤200 个/mm³)329例。通过多因素Logistic回归,分析抗病毒治疗患者耐药发生的影响因素。结果共调查符合条件的抗病毒治疗患者661例,总耐药率为34.3%(227/661),其中早期治疗组、常规治疗组和延迟治疗组出现耐药突变的比例分别为21.2%(28/132)、 35.5%(71/200)和 38.9%(128/329)。多因素Logistic回归分析显示,早期治疗(OR=0.31, 95%CI 0.19~0.51, P<0.001)、依从性高(OR=0.48, 95%CI 0.30~0.78, P=0.003)和含3TC初始治疗方案(OR=0.20, 95%CI 0.20~0.40, P<0.001)是影响抗病毒治疗耐药产生的保护因素,治疗时间长(OR=1.90, 95%CI 1.22~2.95, P=0.004 3)是影响抗病毒治疗耐药产生的危险因素。结论早期开始抗病毒治疗可减少抗病毒治疗患者耐药毒株的产生,能取得良好的抗病毒治疗效果。

关键词: 影响因素, 艾滋病, 早期抗病毒治疗, 耐药

Abstract: Objective To compare the impact of antiretroviral therapy initiated at different stages on drug resistance among AIDS patients. Methods AIDS patients treated with first-line HAART for 6 months in Henan Province were investigated with cross-sectional survey and blood samples were collected. According to the level of baseline immunology, the patients were divided into 3 groups: early treatment group(n=132, CD4⁺T cell counts ≥ 350 cell/mm³), conventional treatment group(n=200, 200 cell/mm³ < CD4⁺T cell counts < 350 cell/mm³)and delayed treatment group(n=329, CD4⁺T cell counts ≤ 200 cell/mm³). The factors associated with the development of HIV-1 drug resistance were analyzed with multivariate logistic regression. Results A total of 661 patients were investigated. The total prevalence of HIV-1 drug resistance was 34.3%(227/661). The prevalence of drug resistance in the early treatment group, conventional treatment group and delayed treatment group was 21.2%(28/132), 35.5%(71/200)and 38.9%(128/329), respectively. Multivariate logistic regression analysis showed that the protective factors associated with the development of drug resistance included earlier treatment(OR=0.31, 95%CI 0.19-0.51, P<0.001), high compliance(OR=0.48, 95%CI 0.30-0.78, P=0.003)and initiation of ART with 3TC(OR=0.20, 95%CI 0.20- 山东大学学报 (医学版)54卷9期 -袁源,等.不同时期抗病毒治疗对艾滋病患者耐药产生的影响分析 \=-0.40, P<0.001), while long-duration of treatment(OR=1.90, 95%CI 1.22-2.95, P=0.004 3)was the risk factor. Conclusion Early initiation of antiretroviral therapy for AIDS patients receiving HAART could reduce the emergence of the drug resistant strains and acquire good effect.

Key words: Acquired Immune Deficiency Syndrome, Early initiation of antiretroviral therapy, Influencing factor, Drug resistance

中图分类号:

R183.9

袁源,司珩,刘宏伟,刘春华,王哲,阮玉华,邢辉. 不同时期抗病毒治疗对艾滋病患者耐药产生的影响分析[J]. 山东大学学报（医学版）, 2016, 54(9): 77-81.

YUAN Yuan, SI Heng, LIU Hongwei, LIU Chunhua, WANG Zhe, RUAN Yuhua, XING Hui. HIV drug resistance and the impact of antiretroviral therapy initiated at different stages among AIDS patiens[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(9): 77-81.

参考文献

[1] Mwesigire DM, Wu AW, Martin F, et al. Quality of life in patients treated with first-line antiretroviral therapy containing nevirapine or efavirenz in Uganda: a prospective non-randomized study[J]. BMC Health Serv Res, 2015,15: 292. doi: 10.1186/s12913-015-0959-0.
[2] Hong SY, Jonas A, DeKlerk M, et al. Population-based surveillance of HIV drug resistance emerging on treatment and associated factors at sentinel antiretroviral therapy sites in Namibia[J]. J Acquir Immune Defic Syndr, 2015, 68(4): 463-471.
[3] Hosseinipour MC, Gupta RK, Van Zyl G, et al. Emergence of HIV drug resistance during first- and second-line antiretroviral therapy in resource-limited settings[J]. J Infect Dis, 2013, 207(Suppl 2): S49-56.
[4] Wang J, Wang Z, Liao L, et al. Efficacy and HIV drug resistance profile of second-line ART among patients having received long-term first-line regimens in rural China[J]. Sci Rep, 2015, 5: 14823. doi: 10.1038/srep14823.
[5] Liao L, Xing H, Su B, et al. Impact of HIV drug resistance on virologic and immunologic failure and mortality in a cohort of patients on antiretroviral therapy in China[J]. AIDS, 2013, 27(11): 1815-1824.
[6] Xing H, Ruan Y, Li J, et al. HIV drug resistance and its impact on antiretroviral therapy in Chinese HIV-infected patients[J]. PLoS One, 2013, 8(2): e54917. doi: 10.1371/journal.pone.0054917. Epub 2013 Feb 6.
[7] Kaleebu P, Kirungi W, Watera C. Virological response and antiretroviral drug resistance emerging during antiretroviral therapy at three treatment centers in uganda[J]. PLoS One, 2015, 10(12): e0145536. doi: 10.1371/journal.pone.0145536. eCollection 2015.
[8] 孙定勇, 王奇, 杨文杰, 等. 河南省2003-2009年艾滋病抗病毒治疗患者生存状况分析[J]. 中华流行病学杂志, 2012, 33(2): 181-184. SUN Dingyong, WANG Qi, YANG Wenjie, et al. Survival analysis on AIDS antiretroviral therapy in Henan province during 2003-2009[J]. Chinese Journal of Epidemiology, 2012, 33(2): 181-184.
[9] 杨文杰, 樊盼英, 梁妍, 等. 2008-2013年河南省艾滋病患者抗病毒治疗对HIV的抑制效果及其影响因素分析[J]. 中华预防医学杂志, 2015, 49(1): 13-20. YANG Wenjie, FAN Panying, LIANG Yan, et al. Analysis on HIV suppression effect after initiating antiretroviral treatment and related factors among AIDS patients in Henan province during 2008 and 2013[J]. Chinese Journal of Preventive Medicine, 2015, 49(1): 13-20.
[10] 中国疾病预防控制中心. 国家免费艾滋病抗病毒治疗手册[M]. 3版.北京: 人民卫生出版社, 2012.
[11] Jiamsakul A, Sungkanuparph S, Law M, et al. HIV multi-drug resistance at first-line antiretroviral failure and subsequent virological response in Asia[J]. J Int AIDS Soc, 2014, 17: 19053. doi: 10.7448/IAS.17.1.19053. eCollection 2014.
[12] 崔卫国, 薛秀娟, 刘佳, 等. 河南省沈丘县抗病毒治疗者HIV耐药株流行状况调查[J]. 中华流行病学杂志, 2013, 34(3): 218-220. CUi Weiguo, XUE Xiujuan, LIU Jia, et al. A cross-sectional study on the prevalence of HIV drug resistance in patients receiving antiretroviral treatment in Shenqiu county, Henan province[J]. Chinese Journal of Epidemiology, 2013, 34(3): 218-220.
[13] Jain V, Byonanebye DM, Amanyire G, et al. Successful antiretroviral therapy delivery and retention in care among asymptomatic individuals with high CD4+ T-cell counts above 350 cells/μl in rural Uganda[J]. AIDS, 2014, 28(15): 2241-2249.
[14] Wang J, He C, Hsi JH, et al. Virological outcomes and drug resistance in Chinese patients after 12 months of 3TC-based first-line antiretroviral treatment, 2011-2012[J]. PLoS One, 2014, 9(2): e88305. doi: 10.1371/journal.pone.0088305. eCollection 2014.
[15] 丁佩佩, 何纲, 陈晓华, 等. 不同CD4+细胞水平HIV感染者抗病毒治疗的疗效及药物不良反应分析[J].中国医师杂志, 2015, 17(1): 52-57. DING Peipei, HE Gang, CHEN Xiaohua, et al. Efficacy and side effects of HAART in HIV-infected patients with different CD4 cell counts[J]. Journal of Chinese Physician, 2015, 17(1): 52-57.
[16] Xing H, Ruan Y, Hsi JH, et al. Reductions in virological failure and drug resistance in Chinese antiretroviral-treated patients due to lamivudine-based regimens, 2003-12[J]. J Antimicrob Chemother, 2015, 70(7): 2097-2103.

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