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Background and Purpose wide application of highly active antiretroviral therapy (HAART) significantly reduce the morbidity and mortality of HIV / AIDS patients, but the resulting virus resistance, has become the main reason for the failure of the anti-viral treatment. Our free antiretroviral treatment has been widely carried out in the country, patients can choose the types of drugs is limited, so to understand our patients resistant to the occurrence of an important significance to improve the effect of antiviral therapy. Earlier primary drug resistance results in parts of the country is not exactly the same, especially the lack of treatment resistance prospective longitudinal study. Therefore, this study aims through national multi-regional HIV / AIDS patients with primary drug research to understand our country did not receive antiviral therapy in patients with primary drug resistance occurrence; initial antiviral therapy in patients with The follow-up study, and explore the secondary drug Occurrence its impact factors. Objects and methods in this study genotypic resistance testing methods through Home-brew 237 cases from 20 regions of the country without antiviral therapy in patients with viral load, CD4 cell count and genotypic resistance testing; screening 190 patients without antiviral treatment, viral load 500 copies / ml, CD4 cell count of 100-350 cells / ul, no serious opportunistic infections in patients randomly assigned to AZT DDI NVP, D4T 3TC NVP, AZT 3TC NVP3 in treatment options group, the the antiviral treatment follow-up period of 52 weeks, the detection of their pre-treatment, treatment after 4,12,24,36,52 weeks after viral load, CD4 cell count, to monitor the course of treatment, the patient's medication adherence, viral load after 12 weeks of treatment in 1000copies/ml patients genotypic resistance testing. Results by cross-sectional study of 237 cases without anti-viral treatment of HIV / AIDS patients from Henan, Yunnan, Shanghai and other 20 regions, may be infected with time the vast majority before 2003, the infection of HIV-1 strains covering the nine different subtypes. Genotypic resistance testing showed 237 patients, only three cases of NRTIs highly resistant and highly resistant to the PIs low degree of resistance and NNRTIs, the occurrence of primary resistance rate was only 1.3% (3/237 ). 190 cases for 52 weeks of antiviral therapy process, 28 patients with viral load greater than 1000 copies / ml after 12 weeks of treatment, 17 cases of patients with secondary resistance (8.9%, 17/190) 16 patients received AZT DDI NVP scheme, patients receiving D4T 3TC NVP scheme, and highly resistant to all of the NNRTIs. NNRTIs resistance-associated locus mutation occurred mainly in the treatment of 24 weeks, K103N, Y181C and G190A, the proportion of the total drug samples, respectively, 35.3% (6/17), 41.2% (7/17) NRTIs resistance-associated mutations occurred mainly after 24 weeks of treatment, and 29.4% (5/17); T215Y proportion of the total drug samples (23.5%, 4/17) and other NRTIs resistance-associated mutations in total drug The proportion of samples at 11.8% or less. 15 patients completed 52 weeks of treatment, viral load greater than 1000 copies / ml in 13 patients with drug resistance (86.7%, 13/15). Analysis of related factors found that patients with poor compliance (<95%) and AZT DDI NVP program is resistance occurs secondary risk factors (P <0.05). After 52 weeks of antiviral therapy, D4T 3TC NVP, AZT 3TC NVP regimen to the patient's viral load suppression below 50 copies / ml the proportion of patients reached 68.8% and 70.4% respectively, while AZT DDI NVP scheme is only 40.3%. The conclusion of this study is our sample size and coverage of the most widely used, the strain of subtype is the most abundant, infection time span is the longest prospective drug research. The study found that the HIV / AIDS patient population in our country without anti-viral treatment of HIV-1 primary drug resistance occurrence ratio at a low level; antiviral treatment process, the lower the cumulative incidence of secondary resistance 190 patients after 52 weeks of antiviral therapy still can not be suppressed viral load patients, secondary resistance is the main reason for the failure of antiviral therapy, poor compliance is a major impact of secondary drug resistance factors; NNRTIs resistance associated sites mutation in the NRTIs drug related sites mutation appears, NNRTIs, NRTIs to T215Y K103N, Y181C, G190A-based; AZT DDI the NVP program inhibit viral effect poor resistance occurred a higher proportion, is not recommended as the preferred solution to anti-viral treatment.
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