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目的:探讨广西地区艾滋病一线抗病毒治疗失败患者的HIV-1耐药突变位点发生率在不同个体因素的差异。方法:采集一线抗病毒治疗>9个月、病毒载量≥1000拷贝/ml的63例艾滋病患者血样标本,采用RT-PCR和RT-nested—PCR从血浆中提取病毒RNA,扩增目的基因片段,并对其进行序列测定和分析,对所得耐药位点在不同临床资料的发生率进行统计学处理分析。结果:58例患者的样本扩增成功,RT区主要耐药位点为M184V、K103N、Y181C。年龄(>50岁)的患者对K65R和K103N发生率比年龄(<30岁)的高,年龄(>50岁)的患者对M184I发生率比年龄(30~50岁)的高,已婚患者对K103N发生率比未婚的高,性接触患者对Y181C发生率比静脉吸毒的高,治疗时间(0.75~1年)的患者对K65R发生率比治疗时间(2~3年)和治疗时间(>4年)的高,治疗时间(2~3年)的患者对D67N发生率比治疗时间(>4年)的高,治疗时间(1~2年)和治疗时间(>4年)的患者对K103N发生率比治疗时间(2~3年)的高,治疗时间(3~4年)的患者对Y181C发生率比治疗时间(1~2年)的高,TDF治疗方案的患者对K65R发生率比AZT方案的高,TDF方案和D4T方案的患者对D67N发生率比AZT方案的高,病毒载量(>5Ig拷贝/mL)的患者对65R发生率比病毒载量(4-5Ig拷贝/mL)的高,以上P值均<0.05。结论:广西地区艾滋病患者一线抗病毒治疗失败主要原因是NRTI和NNRTI相关的耐药突变位点多且发生率高,常见耐药位点的发生在年龄、感染途径、治疗时间、起始治疗方案及病毒载量不同的患者中存在显著差异,可为患者二线或三线治疗方案的制定提供技术指导。
Objective: To investigate the differences in the incidence of HIV-1-resistant mutations in patients with first-line ARV in Guangxi in different individual factors. Methods: A total of 63 AIDS patients with viral load ≥1000 copies / ml were collected for blood samples from first-line antiviral therapy for> 9 months. RNA was extracted from plasma using RT-PCR and RT-nested-PCR to amplify the target gene fragment , And its sequence determination and analysis of the resulting drug-resistant sites in different clinical data on the incidence of statistical analysis. Results: The samples of 58 patients were successfully amplified. The major resistance sites in RT were M184V, K103N and Y181C. Patients with age (> 50 years) have a higher incidence of K65R and K103N than those with age (<30 years), patients with M184I (30-50 years) who are older (> 50 years) The incidence of K103N was higher than that of intravenous drug in patients with high and sexual contact with unmarried, and the incidence of K65R in treatment group was higher than that of intravenous drug in treatment group (0.75 to 1 year) 4 years), patients with high D67N incidence over the treatment time (> 4 years), treatment time (1-2 years) and treatment time (> 4 years) The incidence of K103N was higher than the treatment time (2-3 years), and the treatment time (3-4 years) was higher for Y181C than for treatment time (1-2 years). The incidence of K65R in TDF treatment group was higher Patients with a higher D67N incidence than the AZT regimen, patients with a higher viral load (> 5Ig copies / mL) had a lower incidence of 65R than the viral load (4-5Ig copies / mL) than those with the AZT regimen, TDF regimen and D4T regimen ), All above P <0.05. Conclusion: The primary reason for the failure of first-line antiviral therapy for AIDS patients in Guangxi is the high number and frequent occurrence of drug-resistant mutations associated with NRTI and NNRTI. The common sites of resistance occur in terms of age, route of infection, duration of treatment, initiation of treatment And patients with different viral load, there are significant differences for patients with second-line or third-line treatment programs to provide technical guidance.