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目的分析四川省2011年接受HIV-1抗病毒治疗患者的耐药情况以及耐药株亚型特征。方法对2011年2 292例接受抗病毒治疗1年以上的HIV-1患者进行病毒载量检测,收集病毒载量大于1 000 cps/ml的患者样本,进行PCR和pol基因测序,登录美国斯坦福大学HIV耐药数据库,在线分析确定耐药突变情况,采用DNAStar软件建立系统进化树,确定耐药株亚型,将所得结果与2010年检测结果进行比较。结果 2 292例抗病毒治疗患者中,320例(13.96%)病毒载量结果大于1 000 cps/ml,其中233例(10.17%)样本核酸扩增阳性,111例(4.84%)出现不同程度耐药,比2010年高出1.36个百分点,其中3例对核苷类逆转录酶抑制剂(NRTIs)耐药,29例对非核苷类逆转录酶抑制剂(NNRTIs)耐药,79例对核苷类和非核苷类逆转录酶抑制剂同时耐药,另外有3例对蛋白酶抑制剂(PIs)耐药。耐药患者中,CRF01_AE重组亚型66例(59.46%),CRF07_BC重组亚型23例(20.72%),CRF08_BC重组亚型9例(8.11%),B亚型9例(8.11%),C亚型3例(2.70%),CRF02_AG重组亚型1例(0.90%)。结论四川省HIV-1抗病毒治疗患者耐药水平仍然较低,但相对2010年有所增高,应加强抗病毒治疗患者用药督导,提高患者用药依从性,尽可能防止耐药株的出现。另一方面,耐药患者中出现了CRF02_AG重组毒株,预示该亚型毒株已进入四川省,应防止该毒株的流行。
Objective To analyze the resistance of patients receiving HIV-1 antiviral therapy in Sichuan Province in 2011 and the characteristics of the subtype of resistant strains. Methods HIV-1 was detected in 2 292 HIV-1 patients who received antiviral therapy for more than 1 year in 2011. Samples of patients with viral load greater than 1 000 cps / ml were collected and sequenced. PCR and pol genes were sequenced and registered with Stanford University The HIV drug resistance database was analyzed online to determine the resistance mutation. DNAStar software was used to establish the phylogenetic tree to identify the subtype of drug-resistant strains. The results were compared with the 2010 test results. Results Among 2 292 patients with antiviral therapy, 320 cases (13.96%) had viral load greater than 1 000 cps / ml, of which 233 cases (10.17%) had positive nucleic acid amplification and 111 cases (4.84%) had varying degrees of resistance 1.36 percentage points higher than that of 2010, of which 3 were resistant to nucleoside reverse transcriptase inhibitors (NRTIs), 29 were resistant to non-nucleoside reverse transcriptase inhibitors (NNRTIs), 79 were nuclear Glycosides and non-nucleoside reverse transcriptase inhibitors were resistant at the same time, and three others were resistant to protease inhibitors (PIs). There were 66 (59.46%) CRF01_AE, 23 (20.72%) CRF07_BC, 9 (8.11%) CRF08_BC, 9 (8.11%) B CRF08_BC, 3 cases (2.70%), CRF02_AG recombinant subtype in 1 case (0.90%). Conclusions The level of drug resistance in HIV-1 antiviral treatment in Sichuan province is still low, but it is relatively higher than that in 2010. Drug-use supervision should be strengthened in patients with antiviral therapy to improve drug adherence and prevent the emergence of drug-resistant strains as much as possible. On the other hand, there was a CRF02_AG recombinant strain in drug-resistant patients, indicating that this subtype strain has entered Sichuan Province and should prevent the epidemic.