【摘要】 目的了解我国河南省尉氏县部分获得性免疫缺陷综合征（AIDS）患者在更换二线抗病毒治疗方案后的疗效及耐药情况,并分析可能影响二线方案疗效的相关因素。方法对65例AIDS患者在换药前、二线方案治疗6个月、治疗12个月时分别进行随访调查,并分别行CD₄⁺T细胞、病毒载量及耐药情况检测。结果队列中65例AIDS患者,经二线方案治疗12个月后,CD₄⁺T细胞的均值与基线相比显著升高（t=-2.417、P=0.017）,病毒载量均值显著降低（t=2.343、P=0.021）,病毒载量<400拷贝/ml患者由换药前的6.2%上升至62.3%（χ2=42.704、P<0.001）。换药前患者交叉耐药和多药耐药严重,二线方案治疗12个月后,检出耐药患者比例由换药前78.5%（51/65）下降为11.3%（6/53）;更换二线方案治疗前后均未检测到蛋白酶抑制剂（PI）耐药患者。换药前患者CD₄⁺T<100个/μl和HIV-1 RNA>10 000拷贝/ml与治疗后病毒载量未能有效抑制相关（OR=5.14,95%CI:0.99²6.71;OR=3.36,95%CI:0.66¹7.21）。结论二线抗病毒方案疗效显著。更换二线方案前后均未发现PI耐药,但检出大量蛋白酶抑制剂次要变异,应对更换二线抗病毒治疗方案患者进行长期的耐药监测。更多还原

【Abstract】 Objective To investigate the efficacy and drug resistance of patients with acquired immune deficiency syndrome（AIDS） in Weishi County of Henan province after the change of second-line antiviral therapy, and to analyze the factors which affect the efficacy of second-line therapy. Methods Total of 65 patients with AIDS were followed up before treatment change, 6 months and 12 months after secondline antiviral therapy. The CD4+ T cell counts, viral load and genotypic resistance testing were detected, respectively. Results Among the cohort of 65 patients with AIDS, treatment for 12 months after the secondline, the mean CD₄⁺ T cell significantly increased compared with the baseline（t =-2.417, P = 0.017）, the mean viral load decreased significantly（t = 2.343, P = 0.021）, and patients of viral load < 400 copies/ml increased from 6.2% to 62.3%（χ2 = 42.704, P < 0.001）. Cross resistance and multi-drug resistance were severe in patients with baseline. After 12 months of second-line treatment, the proportion of resistant patients was decreased from 78.5%（51/65） to 11.3%（6/53）; protease inhibitor（PI） resistant patients weren’t detected before and after treatment with second-line regimens. Before the change of dressing, patients with CD₄⁺ T < 100 cells/μl and HIV-1 RNA > 10 000 copies/ml were significantly related to virologic failure（OR = 5.14, 95%CI = 0.99-26.71; OR = 3.36, 95%CI = 0.66-17.21）. Conclusions The second-line antiretroviral therapy was effective. PI drug resistance wasn’t found before and after the secondline regimens was replaced. However, a large number of minor protease inhibitors mutations were detected. Long-term resistance surveillance should be carried out in patients with second-line antiretroviral therapy.更多还原