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目的了解广东省艾滋病长期抗病毒治疗患者耐药情况。方法在接受HAART治疗方案4年以上的120例艾滋病患者,对其中病毒载量大于1 000 copies/ml的22例患者,进行HIV-1耐药基因型检测。采用In-House方法,扩增HIV-l的POL基因蛋白酶区(PR)基因全长和逆转录酶区(RT)基因部分片段,通过HIV-1耐药数据库,获得个体耐药突变位点及药物耐受情况。结果该人群HIV-1病毒未抑制率为18.3%(22/120);基因型高度耐药12例,高度耐药比例为10%,RT区常见耐药突变:Y181C、G190A、K101Q/E/N、M184IMV和K219KR,PR区未见主要耐药突变;常用非核苷类逆转录酶抑制剂奈韦拉平、依非韦伦耐药率分别为100%(12/12),92%(11/12);核苷类逆转录酶抑制剂拉米夫定、恩曲他滨、阿巴卡韦的耐药率分别为83%(10/12)、83%(10/12)和42%(5/12)。结论长期治疗人群中高度耐药个体已超过10%,未发现蛋白酶区耐药病例,核苷类和非核苷类逆转录酶抑制剂均出现高度耐药病例。
Objective To understand the long-term anti-virus treatment of AIDS patients in Guangdong Province. Methods Totally 120 AIDS patients who received HAART for more than 4 years were tested for genotypes of HIV-1 resistance in 22 patients with a viral load greater than 1 000 copies / ml. In-House method was used to amplify the full length of PR gene of HIV-1 and some fragments of reverse transcriptase region (RT) gene. The HIV-1 drug-resistant mutation sites and Drug resistance. RESULTS: The uninhibited rate of HIV-1 virus in this population was 18.3% (22/120). The genotypes were highly resistant in 12 cases and the highly resistant rate was 10%. The common resistance mutations in RT region were Y181C, G190A, K101Q / E / N, M184IMV and K219KR, PR no major drug-resistant mutations; common non-nucleoside reverse transcriptase inhibitors nevirapine, efavirenz resistance rates were 100% (12/12), 92% (11/12) The resistance rates of nucleoside reverse transcriptase inhibitors lamivudine, emtricitabine and abacavir were 83% (10/12), 83% (10/12) and 42% (5 / 12). Conclusions In the long-term treatment population, highly resistant individuals have exceeded 10%. No cases of protease resistance were found. Nucleosides and non-nucleoside reverse transcriptase inhibitors all showed highly resistant cases.