摘要目的 了解河南省柘城县AIDS患者抗病毒治疗后HIV-1耐药毒株流行情况及影响耐药的主要因素.方法 采用横断面调查,对柘城县自2003年7月开始国家免费抗病毒治疗以来到2009年3月接受抗病毒治疗的378例患者进行访谈和血样采集,使用实时荧光定量PCR法测定病毒载量,利用扩增-测序(In-House)法扩增HIV-1 pol区基因,进行基因型耐药性分析.结果 在调查的378例抗病毒治疗患者中,病毒抑制率为42.9%(162/378),47.1%(178/378)的患者检测出基因型耐药,其中针对非核苷类抑制剂(NNRTIs)、核苷类抑制剂(NRTIs)和蛋白酶抑制剂(PIs)3类抗病毒治疗药物的基因型耐药分别占调查人数的46.6%(176/378)、37.8%(143/378)、1.9%(7/378).多因素logistic回归分析显示,依从性差[近1个月按时按量服药比例<90%的耐药率:≥90%的耐药率=64.5%(40/62):43.7%(138/316),OR=2.3,95%CI:1.3~4.1]和含去羟肌苷(DDI)治疗方案[含DDI治疗方案的耐药率:含拉米夫定治疗方案的耐药率=53.3%(137/257):33.9%(41/121),OR=2.3,95%CI:1.1~4.5]是耐药毒株流行的主要影响因素.结论 河南省柘城县抗病毒治疗人群中耐药毒株流行率较高,服药依从性差和含DDI的抗病毒起始治疗方案是影响耐药的主要因素.

abstractsObjective To understand the prevalence of HIV-1 drug resistance and its main factors in AIDS patients receiving to HAART in Zhecheng county,Henan province.Methods By cross-sectional survey,378 AIDS patients who had received the national free antiretroviral therapy from July 2003 to March 2009 in Zhecheng county of Henan were selected.All recruits were interviewed and blood samples were collected.HIV-1 viral loads were measured by real-time polymerase chain reaction,HIV genotypic resistance was determined by an in-house polymerase chain reaction to amplify the HIV-1 pol gene region.Results Among 378 subjects receiving antiretroviral therapy,the prevalence of successful viral suppression was 42.9% (162/378),and HIV-1 drug resistance was detected in 47.1%(178/378) patients.The rate of resistance-associated mutations to non-nucleotide reverse transcriptase inhibitors (NNRTIs),nucleotide reverse transcriptase inhibitors(NRTIs) and protease inhibitors (PIs) was 46.6%(176/378),37.8%(143/378) and 1.9%(7/378),respectively.Multivariate logistic regression analysis showed that the main risk factors associated with the prevalence of drug resistance included drug non-adherence (ratio of on-time drug 43.7%(138/316),OR=2.3,95%CI:1.3-4.1),and initiation of anti-retroviral The prevalence of HIV-1 drug resistance among ART patients in Zhecheng county of Henan was high.Drug non-adherence and initiation of ART with DDI were the main factors of drug resistance.