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[四川省凉山州HIV耐药情况及相关因素分析]

[Drug resistance and associated factors on HIV in Liangshan prefecture, Sichuan province].

作者信息

Wang Qi-xing, Wang Xia, Chen Bin, Ma Zhi-ling, Liang Shu, Liao Ling-jie, Ma Ming-ju, Wei Da-Ying, Qin Guang-ming, Ruan Yu-hua, Shao Yi-ming, Xing Hui

机构信息

Liangshan Prefecture Center for Disease Control and Prevention, Xichang, China.

出版信息

Zhonghua Liu Xing Bing Xue Za Zhi. 2011 Nov;32(11):1082-6.

Abstract

OBJECTIVE

To investigate the HIV drug resistance among HIV/AIDS patients who had received highly active antiretroviral treatment (HAATR) in Liangshan prefecture and related factors.

METHODS

This investigation was conducted from August to October 2010. Data on epidemiology, treatment, CD4(+) T cell, viral load and drug resistance tests were collected.

RESULTS

233 (73.50%) had a viral load of < 1000 copy/ml, with the median CD4(+) T cell count as 329 cell/µl. 26 samples appeared to be drug resistant, with the rate as 8.20%. Among 84 patients with antiviral therapy failure, the overall drug resistance rate was 30.95% (26/84). While 24 (28.57%) were resistant to non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs. Among nucleoside reverse transcriptase inhibitors (NRTI), 7 (8.33%) were resistant. 1 (1.19%) had protease inhibitor (PI) resistance mutations identified. Factors that significantly associated with drug resistance would include: being injecting drug users (AOR = 3.37, 95%CI: 1.06 - 10.66, P = 0.0390), having had chronic diarrhea > 1 month (AOR = 8.38, 95%CI: 1.87 - 37.69, P = 0.0055), having had CD4(+) T cell < 200 (AOR = 3.48, 95%CI: 1.29 - 9.39, P = 0.0139), being residents from Butuo area (AOR = 17.68, 95%CI: 4.97 - 62.86, P < 0.0001). When comparing with other areas, data from Butuo showed that people who carried Yi ethnicity (AOR = 17.35, 95%CI: 2.01 - 149.73, P = 0.0095) and were literate (having had primary or higher levels of education) (AOR = 0.18, 95%CI: 0.08 - 0.42, P < 0.0001), being married or having cohabited relations (AOR = 8.17, 95%CI: 2.35 - 28.39, P = 0.001) were found to be less adherent (AOR = 0.05, 95%CI: 0.02 - 0.13, P < 0.0001) to the treatment.

CONCLUSION

Successful antiviral outcomes were seen among those AIDS patients under treatment, in Liangshan prefecture. Resistance rates were significantly different in regions. For IDUs, enforcement on subjects including prevention on drug resistance, adherence to HAART and treatment for drug addiction should be strengthened and programs being integrated.

摘要

目的

调查凉山州接受高效抗逆转录病毒治疗(HAART)的艾滋病病毒(HIV)/获得性免疫缺陷综合征(AIDS)患者的HIV耐药情况及相关因素。

方法

于2010年8月至10月进行此项调查。收集流行病学、治疗、CD4(+) T淋巴细胞、病毒载量及耐药检测数据。

结果

233例(73.50%)病毒载量<1000拷贝/毫升,CD4(+) T淋巴细胞计数中位数为329个/微升。26份样本出现耐药,耐药率为8.20%。在84例抗病毒治疗失败的患者中,总体耐药率为30.95%(26/84)。其中,24例(28.57%)对非核苷类逆转录酶抑制剂(NNRTI)耐药。在核苷类逆转录酶抑制剂(NRTI)中,7例(8.33%)耐药。1例(1.19%)检测到蛋白酶抑制剂(PI)耐药突变。与耐药显著相关的因素包括:为注射吸毒者(比值比[AOR]=3.37,95%可信区间[CI]:1.06 - 10.66,P=0.0390)、慢性腹泻>1个月(AOR=8.38,95%CI:1.87 - 37.69,P=0.0055)、CD4(+) T淋巴细胞<200个(AOR=3.48,95%CI:1.29 - 9.39,P=0.0139)、来自布拖地区(AOR=17.68,95%CI:4.97 - 62.86,P<0.0001)。与其他地区相比,布拖的数据显示,彝族(AOR=17.35,95%CI:2.01 - 149.73,P=0.0095)、有文化(小学及以上学历)(AOR=0.18,95%CI:0.08 - 0.42,P<0.0001)、已婚或同居(AOR=8.17,95%CI:2.35 - 28.39,P=0.001)的人群治疗依从性较低(AOR=0.05,95%CI:0.02 - 0.13,P<0.0001)。

结论

凉山州接受治疗的艾滋病患者抗病毒治疗效果良好。不同地区耐药率存在显著差异。对于注射吸毒者,应加强包括耐药预防、HAART依从性及戒毒治疗等方面的工作,并将各项工作整合起来。

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