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河南省26例HIV感染长期不进展者病程进展及耐药情况
作者:薛秀娟 田随安 朱谦 孙定勇 王哲

摘要:

目的  分析河南省HIV感染长期不进展人群3次随访过程中病程进展情况及耐药情况。方法  于2009年5月,选取河南省艾滋病重点疫情地区尉氏、上蔡、临颍县为研究现场,招募26例经既往采供血途径感染HIV、感染时间>10年、未接受抗逆转录病毒治疗、CD4+T淋巴细胞计数≥ 350个/μl并未出现艾滋病典型症状的长期不进展者。采用队列分析方法,自2009年开始每两年随访1次,连续随访3次。收集感染途径、感染时间等流行病学信息。每次随访均采集研究对象10 ml乙二胺四乙酸抗凝全血,共采集78份。分析2009—2014年期间CD4+T淋巴细胞计数、病毒载量、病毒基因的变化情况。采用in-house方法,探讨长期不进展人群的原发耐药状况。采用非参数Kruskal-Wallis检验比较不同随访时间研究对象CD4+T淋巴细胞计数和病毒载量变化。结果  26例研究对象的年龄为(48.51±6.75)岁,感染时间为(13.42±4.26)年。3次随访中,CD4+T淋巴细胞计数的P50 (P75~P25)分别为573.5 (487.4~789.8)、499.8(403.5~635.7)和418.8 (297.6~537.8)个/μl (H=63.99 ,P<0.001),病毒载量自然对数的P50 (P25~P75)分别为3.93 (3.43~4.55)、4.29(3.78~4.75)、4.50(4.01~4.81)(H=3.19,P= 0.355);HIV亚型及系统进化分析显示,感染者以B亚型为主,占88.5%(23/26),3例出现重组变化。18例病毒载量>1 000拷贝/ml的感染者中,有2例出现中高度耐药。结论  河南省长期不进展人群CD4+T淋巴细胞计数有逐年下降的趋势,少数感染者病毒亚型出现重组变化,同时存在原发耐药现象。

关键词:HIV;抗药性;病毒亚型

Abstract:

Objective  To investigate the progression and drug resistance of long-term non-progressors during three follow-up in Henan province.Methods  In May 2009, 26 cases of long-term non-progressors were recruited who infected HIV more than 10 years with blood collection and supply routes, did not receive anti-retroviral therapy, CD4+T lymphocyte count ≥350/μl and did not show typical symptoms of AIDS from Weishi, Shangcai, and Linying of Henan Province. Continuous follow-up were conducted three times since 2009 every two years with cohort analysis, the epidemiological information of infection routes, infection time and blood were collected, and 78 parts of 10 ml EDTA anticoagulated whole blood were collected. The changes of CD4 + T lymphocytes, viral load, and virus gene variety were characterized from 2009 to 2014. In-house methods were used to explore primary drug resistance of long-term non-progressors. Nonparametric Kruskal-Wallis test were used to compare CD4+ T lymphocyte count and viral load changes during different follow-up times.Results  The average age and infection time of 26 cases were (48.51±6.75) years, (13.42±4.26) years, respectively. Three follow-up times, CD4+ T lymphocyte count P50 (P25-P75) was 573.5 (487.4-789.8), 499.8 (403.5-635.7), and 418.8 (297.6-537.8)/μl (H=63.99,P<0.001), respectively. And natural logarithm of viral load P50 (P25-P75) were 3.93 (3.43-4.55), 4.29 (3.78-4.75), 4.50 (4.01-4.81) (H=3.19,P=0.355), respectively. Subtype and phylogenetic analysis of HIV showed that prevalent cases were B subtype, accounting for 88.5% (23/26), and three cases showed restructuring changes. Two cases appeared highly resistant of 18 infected patients whose viral load >1 000 copies/ml.Conclusion  The CD4+T lymphocyte had a declining trend, virus subtype recombinant changes in a few cases, and primary drug resistance was found of long-term non-progressors in Henan province.

Key words: HIV;Drug resistance;Virus subtype

发表日期:2016/2

引用本文:

图/表:

  • 10.3760/cma.j.issn.0253-9624.2016.02.008.T001:表1 HIV毒株gag基因区扩增引物序列

    10.3760/cma.j.issn.0253-9624.2016.02.008.T001:表1 HIV毒株gag基因区扩增引物序列

  • 10.3760/cma.j.issn.0253-9624.2016.02.008.F001:图1 河南省HIV感染长期不进展者3次随访的HIV毒株系统进化分析图(n=26)

    10.3760/cma.j.issn.0253-9624.2016.02.008.F001:图1 河南省HIV感染长期不进展者3次随访的HIV毒株系统进化分析图(n=26)

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