Xiao P P, Lu J, Hu H Y, Xu X Q, Ding P, Fu G F, Huan X P, Zhou Y, Yang H T
Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2017 Nov 6;51(11):988-993. doi: 10.3760/cma.j.issn.0253-9624.2017.11.007.
To understand the incidence and related factors of HIV-1 drug resistance among HIV/AIDS patients experiencing treatment failure in Jiangsu province, China. The HIV/AIDS integrated prevention and control data information management system of China were used to collect the basic data of patients, blood specimens were collected from patients who had antiretroviral therapy (ART) failure with ≥12 months and older than 18 years in 2016 in Jiangsu, excluding cases with missing information, 713 cases were enrolled in this study. HIV-1 RNA was extracted, and then pol gene region was amplified and sequenced. The obtain sequences were submitted to Stanford University HIV Drug Resistance Database to interpret and analyse HIV-1 drug resistance and sub-types. Multivariate logistic regression model was used to explore the related factors of drug resistance. A total of 579 subjects were amplified successfully, male accounted for 85.66% (496 cases), and the median age was 39 years old. The main route of infection was sexual transmission (553 cases, 95.51%). A total of 331 patients with drug resistance gene mutation were detected, drug resistance mutation rate was 57.18%. Compared with patients with baseline CD4(+)T cell count 500 cells/μl, patients with CD4(+)T cell count in 201-500 cells/mm(3) and ≤200 cells/μl had a higher incidence of genetic drug resistance, the odds ratio was 3.33 and 6.87, respectively. Compared with patients with treatment less than 24 months, patients treated for 25-48 months had a higher incidence of drug resistance, the odds ratio was 1.88. Compared with patients infected by CRF07_BC strains, patients infected by CRF01_AE strains were associated with higher incidence of drug resistance, the odds ratio was 2.22 and 3.32, respectively. Protease inhibitor (PI) resistance mutations, nucleoside reverse transcriptase inhibitor (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) were found in 3.80%, 33.16% and 53.37% of patients, respectively. 31.95% of patients harbored NRTI and NNRTI resistance mutations simultaneously. M184V/I and K103N/Q were the highest frequency of NRTI and NNRTI resistance mutation, the prevalence of M184V/I and K103N/Q were 28.15% and 22.28%, respectively. The status of HIV-1 drug resistance mutations are complex and diverse among patients experiencing failure of ART in Jiangsu. Patients with lower baseline CD4(+)T cell count, longer treatment time and HIV-1 CRF01_AE and B strains infection were associated with higher incidence of drug resistance mutation.
为了解中国江苏省接受治疗失败的HIV/AIDS患者中HIV-1耐药的发生率及相关因素。利用中国HIV/AIDS综合防治数据信息管理系统收集患者的基本资料，采集2016年在江苏省接受抗逆转录病毒治疗（ART）失败且治疗时间≥12个月、年龄大于18岁患者的血标本，排除信息缺失病例，共纳入713例患者。提取HIV-1 RNA，然后扩增pol基因区域并测序。将获得的序列提交至斯坦福大学HIV耐药数据库以解读和分析HIV-1耐药及亚型。采用多因素logistic回归模型探索耐药的相关因素。共成功扩增579例受试者，男性占85.66%（496例），中位年龄为39岁。主要感染途径为性传播（553例，95.51%）。共检测到331例耐药基因突变患者，耐药突变率为57.18%。与基线CD4(+)T细胞计数＞500个/μl的患者相比，CD4(+)T细胞计数在201 - 500个/mm(3)和≤200个/μl的患者发生基因耐药的发生率更高, 比值比分别为3.33和6.87。与治疗时间小于24个月的患者相比，治疗25 - 4个月的患者耐药发生率更高，比值比为1.88。与感染CRF07_BC毒株的患者相比，感染CRF01_AE毒株的患者耐药发生率更高，比值比分别为2.22和3.32。蛋白酶抑制剂（PI）耐药突变、核苷类逆转录酶抑制剂（NRTI）和非核苷类逆转录酶抑制剂（NNRTI）耐药突变分别在3.80%、33.16%和53.37%的患者中被发现。31.95%的患者同时存在NRTI和NNRTI耐药突变。M184V/I和K103N/Q是NRTI和NNRTI耐药突变的最高频率，M184V/I和K103N/Q 的流行率分别为28.15%和22.28%。江苏省接受ART治疗失败患者中HIV-1耐药突变情况复杂多样。基线CD4(+)T细胞计数较低、治疗时间较长以及感染HIV-1 CRF01_AE和B毒株的患者耐药突变发生率较高。
