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山东大学学报（医学版） ›› 2016, Vol. 54 ›› Issue (9): 77-81.doi: 10.6040/j.issn.1671-7554.0.2016.005

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不同时期抗病毒治疗对艾滋病患者耐药产生的影响分析

袁源1,司珩1,刘宏伟1,刘春华1,王哲1,阮玉华2,邢辉2   

  1. 1.河南省疾病预防控制中心性病艾滋病防治研究所, 河南 郑州 450016;2.中国疾病预防控制中心性病艾滋病预防控制中心, 北京102206
  • 收稿日期:2016-01-04 出版日期:2016-09-10 发布日期:2016-09-10
  • 通讯作者: 刘宏伟. E-mail:Hongweiliu36@163.com E-mail:Hongweiliu36@163.com
  • 基金资助:
    河南省重点科技攻关计划(102102310003、112102310005)

HIV drug resistance and the impact of antiretroviral therapy initiated at different stages among AIDS patiens

YUAN Yuan1, SI Heng1, LIU Hongwei1, LIU Chunhua1, WANG Zhe1, RUAN Yuhua2, XING Hui2   

  1. 1. Institute for AIDS/STD Prevention and Cure, Henan Center for Disease Control and Prevention, Zhengzhou 450016, Hennan, China;
    2. National Center for AIDS/STD Control and Prevention, China CDC, Beijing 102206, China
  • Received:2016-01-04 Online:2016-09-10 Published:2016-09-10

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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
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