论文部分内容阅读
目的研究我国某地区 HAART 治疗的儿童 HIV-1基因型耐药变异情况,为临床治疗HIV-1感染儿童提供参考实验室参考数据。方法利用 RT-PCR 和套式 PCR 从20例 HAART 治疗失败的 HIV-1感染儿童的血浆中提取的病毒 RNA 扩增 HIV-1逆转录酶基因(RT)第40～250位氨基酸,直接将 PCR 产物进行序列测定分析,利用斯坦福大学网站提供的 HIV db 数据库分析该两个区域的耐药基因变异情况。结果(1)20例患儿根据 RT 区基因分型结果显示均为 B 亚型;(2)分别有20、15、13例患儿对 NVP、DLV 和 EFV 产生了高度耐药;分别有7例、5例患儿对 AZT 产生了高、中度耐药;有5例患儿对3TC 产生了从潜在低度-中度耐药突变,而有11例患儿出现了高度耐药突变;针对 d4T、ddI 的中、高度耐药共占11/20;此外,19例患儿出现了针对从未服用的 ABC 的不同程度的耐药突变,12例患儿出现了针对 TDF 的不同程度的耐药突变。结论 HIV-1耐药突变株的出现是儿童抗病毒治疗失败的主要原因之一,对于正在抗病毒治疗中的 HIV-1患儿,应及时进行耐药变异监测,及早发现耐药变异,及时改变抗病毒治疗药物以达到真正的病毒抑制效果。
Objective To study the resistance variation of HIV-1 genotypes in children under HAART in our country and to provide reference laboratory reference data for clinical treatment of HIV-1 infected children. Methods RT-PCR and nested PCR were used to amplify amino acids 40 to 250 of the HIV-1 reverse transcriptase gene (RT) from the viral RNA extracted from the plasma of 20 HIV-1 infected children who failed HAART treatment. PCR was performed directly The products were sequenced and analyzed for resistance gene variation in the two regions using the HIV db database provided by the Stanford University website. Results (1) According to the genotyping results of RT region, 20 cases were all subtypes B; (2) There were 20, 15 and 13 cases of children with high resistance to NVP, DLV and EFV respectively; 7 In 5 cases, high and moderate resistance to AZT occurred in 5 children; 5 children developed potentially low-moderate resistance mutations to 3TC while 11 children developed highly resistant mutations; In d4T, the high and medium resistance of ddI accounted for 11/20. In addition, 19 patients had different degrees of resistance mutations to ABC which had never been taken, and 12 patients showed different degrees of resistance to TDF Drug-resistant mutation. Conclusion The emergence of HIV-1-resistant mutants is one of the main reasons for the failure of antiviral therapy in children. In HIV-1-resistant children undergoing antiviral therapy, surveillance of drug-resistant mutations should be carried out in time to detect drug-resistant mutations in time and promptly Change the antiviral treatment to achieve true viral suppression.