State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, China.
Trop Med Int Health. 2010 Nov;15(11):1357-63. doi: 10.1111/j.1365-3156.2010.02621.x. Epub 2010 Sep 25.
To evaluate HIV drug resistance (HIVDR) among Chinese patients with HIV receiving first-line highly active antiretroviral therapy (HAART).
Based on the WHO HIVDR surveys, a prospective cohort study with 12-month follow-up was conducted to estimate the prevalence of HIV RNA<1000 copies/ml and HIVDR.
A total of 341 study subjects naïve to prior antiretroviral therapy (ART) were followed up for a median of 12.1 months. The overall mortality rate was 9.9 per 100 person-years. The median of CD4 counts increased from 182 cells/mm(3) at baseline to 268 cells/mm(3) at 12 months (P<0.0001). Of patients with plasma HIV-1 RNA concentrations ≥1000 copies/ml at 12 months, the proportions of resistance to non-nucleoside reverse transcriptase drugs, nucleoside/nucleotide reverse transcriptase inhibitors, and protease inhibitor drugs were 34.2%, 23.7% and 0%, respectively. The overall proportion of HIV RNA<1000 copies/ml was 85.7% at 12 months. Occupation of farmer (AOR=0.3, 95% CI: 0.08, 0.94; P=0.0393) and HAART counselling and instruction through telephone (AOR=2.8, 95% CI: 1.4, 5.6; P=0.0047) were significantly associated with HIV RNA<1000 copies/ml.
Our study demonstrated that the community-based ART had significant effects on viral suppression and immune recovery. HIVDR should be monitored in the long term to guide informed decisions on preventing HIVDR and choices of first- and second-line regimens.
评估中国接受一线高效抗逆转录病毒治疗（HAART）的 HIV 感染者中 HIV 耐药情况。
基于世界卫生组织（WHO）的 HIV 耐药调查，进行了一项前瞻性队列研究，随访 12 个月，以估计 HIV RNA<1000 拷贝/ml 和 HIV 耐药的发生率。
共对 341 例未接受过抗逆转录病毒治疗（ART）的研究对象进行了随访，中位随访时间为 12.1 个月。总死亡率为每 100 人年 9.9 例。CD4 计数中位数从基线时的 182 个细胞/mm3 增加到 12 个月时的 268 个细胞/mm3（P<0.0001）。12 个月时 HIV-1 RNA 浓度≥1000 拷贝/ml 的患者中，对非核苷类逆转录酶抑制剂、核苷/核苷酸逆转录酶抑制剂和蛋白酶抑制剂的耐药比例分别为 34.2%、23.7%和 0%。12 个月时，HIV RNA<1000 拷贝/ml 的总体比例为 85.7%。职业为农民（AOR=0.3，95%CI：0.08，0.94；P=0.0393）和通过电话进行 HAART 咨询和指导（AOR=2.8，95%CI：1.4，5.6；P=0.0047）与 HIV RNA<1000 拷贝/ml 显著相关。
本研究表明，社区为基础的 ART 对病毒抑制和免疫恢复有显著效果。应长期监测 HIVDR，以指导知情决策，防止 HIVDR，并选择一线和二线方案。
