2020年山东省 ≥ 15岁HIV/AIDS患者抗病毒治疗耐药影响因素分析

李桂蓉; 王俪璇; 朱晓艳; 李亚君; 李玲; 孙晓光; 赵帅; 张娜; 王国永; 康殿民

doi:10.11847/zgggws1142626

2020年山东省 ≥ 15岁HIV/AIDS患者抗病毒治疗耐药影响因素分析

Influencing factors of antiretroviral therapy resistance among HIV/AIDS patients aged ≥ 15 years in Shandong province: a registration data-based case-control analysis

摘要

摘要:
目的分析山东省艾滋病病毒感染者/艾滋病（HIV/AIDS）患者抗病毒治疗耐药的影响因素。
方法对山东省2020年1 — 12月接受抗病毒治疗时间 > 6个月、年龄 ≥ 15岁12608例HIV/AIDS患者进行病毒载量检测，并在检测病毒载量（VL） > 1000拷贝/mL的样本中进行耐药基因型检测。将病毒学应答失败且基因测序结果对 ≥ 1种抗病毒治疗药物存在低度及以上者认定为耐药患者。选择100例耐药患者（耐药组）和131例非耐药患者（非耐药组）进行抗病毒治疗耐药影响因素问卷调查。采用χ²检验和logistic回归模型分析耐药相关影响因素。
结果有效检测12521例患者，抗病毒治疗耐药率为1.74%（218/12521）；获得有效问卷223份，其中耐药组97份，非耐药组126份，logistic多因素回归分析结果显示，治疗时间相差1～12个月的患者是及时治疗者发生耐药的2.74倍（95%CI = 1.18～6.33）；更换过1、2、3次药物组合者是未换药的12.62倍（95%CI = 5.44～29.23）、39.96倍（95%CI = 10.10～158.15）、12.01倍（95%CI = 1.60～90.40）；无人督服药者是有人监督的3.08倍（95%CI = 1.39～6.84）。中、高依从性服药（OR = 0.10，95%CI = 0.04～0.27；OR = 0.07，95%CI = 0.02～0.19）是发生耐药的保护性因素。
结论山东省艾滋病抗病毒治疗耐药的危险因素是未及时启动治疗、一次或多次换药、无人监督服药，提高服药的高依从性可以减少耐药的发生。

Abstract:
Objective To analyze influencing factors of antiretroviral therapy (ART) resistance among human immuno-deficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in Shandong province.
Methods During 2020 in Shandong province, viral load detection was conducted among 12 608 HIV/AIDS patients aged ≥ 15 years and receiving ART more than 6 months and HIV drug resistance genotyping was performed for the 564 patients with ART failure (viral load > 1 000 copies/mL). Of the 477 ART failure patients with successful PCR amplification and HIV sequencing, 218 were assessed as having resistance to one or more antiretroviral drugs based on the results of HIV sequencing referring to the Stanford HIV Resistance Database. Then, a face-to-face interview with a self-designed questionnaire was carried out among 100 of the 218 ART resistance cases and 131 gender-, age-, current address-matched controls selected from the HIV patients sensitive to ART. Chi-square test, Fisher′s exact probability test and logistic regression model were used to analyze factors related to ART resistance.
Results For the 12 521 HIV/AIDS patients completing the viral load detection, 218 (1.74%) were resistant to ART. Valid responses were obtained from 97 cases and 126 controls in the questionnaire interview. Logistic regression analysis revealed following risk factors of ART resistance: with delayed treatment of 1 – 12 months compared to the treatment in time (adjusted odd ratio aOR = 2.74, 95% confidence interval 95%CI: 1.18 – 6.33), frequency of ART regimen change (once: aOR = 12.62, 95%CI: 5.44 – 29.23; twice: aOR = 39.96, 95%CI: 10.10 – 158.15; and thrice: aOR = 12.01, 95%CI: 1.60 – 90.40), and without supervision on ART (aOR = 3.08, 95%CI: 1.39 – 6.84); the analysis also showed that moderate adherence (aOR = 0.10, 95%CI: 0.04 – 0.27) and high adherence (aOR = 0.07, 95%CI: 0.02 – 0.19) to ART were protective factors against ART resistance.
Conclusion Delayed time of ART, changing ART regimen and without supervision on ART are risk factors but high compliance to ART is a protective factor for ART resistance among HIV/AIDS patients receiving ART in Shandong province.

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