目的 了解阜阳市HIV抗病毒治疗患者的耐药情况及影响因素,指导HIV患者抗病毒治疗的临床用药。 方法 收集2016年阜阳地区抗病毒治疗大于12个月且病毒载量≥1 000 cps/ml的253例HIV/AIDS病例样本,应用巢式PCR进行扩增、测序及亚型鉴定,并登录国际耐药库进行比对,以确定耐药水平和耐药基因突变情况。结果 253例样本中,获得有效基因序列216例。基因分型以B亚型为主(83.3%),其次是CRF01＿AE亚型(10.2%),并在不同的感染途径中亚型分布显著不同。87例患者耐药,HIV-1病毒治疗失败人群耐药率为40.3%。耐药发生与传播途径、基线CD4和使用及更换二线治疗方案相关。21.1%患者针对NRTI突变,突变率最高是M184V;41.7%患者针对NNRTI突变,突变率最高是K103N。2例(0.9%)产生了PR区基因突变,1例为主要基因突变,突变位点为M46I、I54V、V82A。50.6%的耐药患者中同时对NNRTI类和NRTI类耐药,10.3%的患者对11种逆转录酶抑制剂全部耐药。结论 阜阳市HIV-1病毒总体耐药程度较低,但在已产生耐药的患者中交叉耐药严重,少数患者对所有逆转录酶耐药,并出现了针对PI的耐药株,应加强耐药监测,及时调整治疗方案,提高治疗效果。

Objective To understand the drug-resistance of patients with HIV antiviral therapy in Fuyang and provide the basis for effective antiviral therapy. Methods A total of 253 cases of HIV/AIDS patients with antiviral treatment over 12 months and viral load ≥ 1000cps/ml in 2016 were collected. Nested PCR was used to amplify, sequenced and identify the subtypes, and to compare it to the international drug bank to determine the level of resistance and the mutation of drug resistance genes. Results A total of 216 cases of effective gene sequence were identified with the B subtype (83.3%) and CRF01 AE subtype (10.2%), and there were significant differences in the subtype distribution between different infective modes. Drug-resistance in 87 patients, and the drug-resistance rate of HIV-1 virus was 40.28%. The occurrence of drug-resistance was significantly associated with the route of transmission, the baseline CD4, and use and replace of the second line treatment scheme. 21.1% patients were directed against NRTI mutation, and the highest mutation rate was M184V. 41.66% patients were directed against NNRTI mutation. The highest mutation rate was K103N, and the Gene mutation in PR region was produced in 2 cases (0.9%), with the main gene mutations of M46I, I54V and V82A in 1 case. 50.6% of drug-resistant patients were resistant to class NNRTI and NRTI, while 10.3% of the patients were all resistant to 11 reverse transcriptase inhibitors. Conclusion The general drug-resistance of HIV-1 virus in Fuyang was low, but cross resistance was serious in patients who had been resistant to drug.A few patients were resistant to all reverse transcriptase with a drug-resistant strain for PI. Drug-resistance monitoring should be strengthened, so as to adjust the treatment plan in time and improve the effect of treatment.