Yao Shitang, Yang Jin, Zhou Lin, Li Yanling, Wang Jibao, Gao Jie, Xu Yuanwu, Yang Wenqin, Li Pinyin, Shi Yun, Zhang Yindi, Cao Dongdong, Yang Meisong, Zhai Zhijian, Xiang Lifen, Yang Yuecheng, Ye Runhua, He Na, Duan Song
Dehong Prefecture Center for Disease Control and Prevention in Yunnan, Mangshi 678400, China.
Department of Epidemiology and Key Laboratory of Public Health Safety, School of Public Health, Fudan University.
Zhonghua Liu Xing Bing Xue Za Zhi. 2014 Apr;35(4):411-6.
To understand HIV rival suppression and drug resistance (HIVDR) among AIDS patients who were receiving antiretroviral treatment (ART) in Dehong prefecture, Yunnan province.
All AIDS patients who were aged over 15 years and with experience more than six months on ART by the end of 2012 in Dehong prefecture, were enrolled to receive testing for HIV viral load in plasma and genetic mutations associated with HIVDR.
A total of 4 390 AIDS patients were qualified for the study according to the selection criteria, of whom 3 964 (90.3%) finally participated in the study. Among them, 2 307(58.2%) had CD₄(+) cell counts more than 350 cells/mm³. 3 169 (79.9%) patients showed undetectable plasma HIV viral load which was lower than the detection threshold. Those who had the following factors as:resided in Ruili city, being female, older than 45 years of age, married, heterosexually infected with HIV, having received ART more than 5 years, and CD₄(+) cell counts >500 cells/mm³, were more likely to have undetectable plasma virus load, with the differences statistically significant. 402 (10.1%) patients had plasma viral load ≥ 1 000 copies/ml, of whom 353 (87.8%) were successfully amplified and examined for HIVDR. Among them, 198 (56.1% ) were identified to bear genetic mutations associated with HIVDR. Most mutations were related to the resistance to nucleotide reverse transcriptase inhibitors (NNRTIs) or non-nucleotide reverse transcriptase inhibitors (NNRTIs), with M184V and K103N most frequently seen. 12 patients (3.4%) were found to have mutations resistant to protease inhibitors (PI). Data from multiple logistic regression analysis indicated that the period of receiving ART and the initial ART regimen could both significantly predict the occurrence of HIV resistance.
Viral suppression was highly achieved among ART-prescribed AIDS patients in Dehong prefecture,Yunnan province. However, among those who did not show effective viral suppression, the proportion of HIVDR was high, underscoring the needs for health education so as to improve the adherence to drugs as well as for improving testing for viral load and HIVDR among AIDS patients.
了解云南省德宏州接受抗逆转录病毒治疗（ART）的艾滋病患者中人类免疫缺陷病毒（HIV）病毒载量抑制及耐药情况（HIVDR）。
纳入德宏州所有年龄大于15岁且截至2012年底接受ART超过6个月的艾滋病患者，进行血浆HIV病毒载量检测及与HIVDR相关的基因突变检测。
共有4390例艾滋病患者符合研究入选标准，其中3964例（90.3%）最终参与研究。其中，2307例（58.2%）的CD₄(+)细胞计数大于350个/立方毫米。3169例（79.9%）患者血浆HIV病毒载量低于检测阈值，未被检测到。居住在瑞丽市、女性、年龄大于45岁、已婚、经异性传播感染HIV、接受ART超过5年以及CD₄(+)细胞计数>500个/立方毫米的患者更有可能血浆病毒载量未被检测到，差异有统计学意义。402例（10.1%）患者血浆病毒载量≥1000拷贝/毫升，其中353例（87.8%）成功扩增并进行HIVDR检测。其中，198例（56.1%）被鉴定出携带与HIVDR相关的基因突变。大多数突变与对核苷类逆转录酶抑制剂（NNRTIs）或非核苷类逆转录酶抑制剂（NNRTIs）耐药有关，最常见的是M184V和K103N。12例（3.4%）患者被发现有对蛋白酶抑制剂（PI）耐药的突变。多因素逻辑回归分析数据表明，接受ART的时间和初始ART方案均能显著预测HIV耐药的发生。
云南省德宏州接受ART治疗的艾滋病患者病毒抑制效果良好。然而，在病毒抑制效果不佳的患者中，HIVDR比例较高，强调需要开展健康教育以提高患者的服药依从性，并加强艾滋病患者的病毒载量及HIVDR检测。
