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［摘要］ 目的 了解宜宾市 HIV 感染者 ( 包括 HIV 感染者和 AIDS) 接受抗病毒治疗后的耐药发生状况、HIV－1 毒株 耐药基因型以及区县分布; 为宜宾市建立有效的艾滋病防控措施和制订合理的抗病毒治疗方案提供科学依据，同时指 导临床对感染者尤其对耐药患者的用药。方法 对 2010－2015 年宜宾市接受 HAAＲT 治疗超过 6 个月的 HIV 感染者， 先进行病毒载量 ( VL) 检测，对 VL≥1 000 cps/ml 的样本进行 PCＲ 扩增、电泳、纯化、基因测序，再对获得序列编 辑、拼接、校正、建构基因进化树确定基因型、在线分析耐药突变种类以及突变位点。结果 2010－2015 年宜宾市接 受 VL 检测的 HIV 感染者有1 693 例，其中有465 例 VL≥1 000 cps/ml，249 例 PCＲ 扩增阳性，120 例发生耐药，耐药 率为 7. 09%。耐药患者以对核苷类反转录酶抑制剂 ( NＲTIs) 和非核苷类反转录酶抑制剂 ( NNＲTIs) 耐药为主，对 NＲTIs 耐药的患者几乎同时对 NNＲTIs 耐药，交叉耐药情况严重; 耐药患者以翠屏区最多。结论 宜宾市 HIV 耐药疫 情呈现中度流行。2010－2015 年宜宾市 HIV 耐药人数呈现逐年增加趋势。耐药患者以耐 NＲTIs 和 NNＲTIs 为主，交叉 耐药比较严重，且对 NNＲTIs 的耐药情况更严重。宜宾市各区县耐药患者分布不均，以翠屏区最多。
［关键词］ HIV; 耐药; HAAＲT
［中图分类号］ Ｒ512. 9 ［文献标识码］ A ［文章编号］ 1672－2116 ( 2018) 02－069－07
作者单位: 1 四川大学华西公共卫生学院 ( 成都 610041)
2 宜宾市疾病预防控制中心 ( 四川 宜宾 644000)
3 四川省疾病预防控制中心 ( 成都 610041)
作者简介:黄晓玲 ( 1983－) ，女，硕士，主管检验师，艾滋 病检测
通信作者:许欣 ( 1962－) ，男，硕士，教授，微生物/公众 健康与检验，Email: 13880862635@ 163. com
Drug Ｒesistance in HIV－Infected Persons Ｒeceiving HIV Antiviral Therapy From 2010 to 2015
Abstract Objective To investigate the drug resistance situation and drug－resistant genotypes of HIV－1 strains in HIV patients ( including HIV infected person and patients with AIDS ) in Yibin following antiviral treatment and distribution in districts and counties so as to provide a scientific basis for establishing effective AIDS prevention and control measures and making up a rational antiviral treatment plan and guide clinical drug administration in infected persons particularly patients who have developed drug resistance． Methods In 2010 to 2015，in HIV－infected persons having received HAAＲT therapy for more than 6 months in Yibin， initial viral loads ( VL) were measured． For samples with VL ≥ 1 000 cps/ml，PCＲ amplification， electrophoresis，purification and gene sequencing were conducted． The obtained sequences were edited，spliced and corrected． A phylogenetic tree was constructed to identify genotypes，and drug resistance mutation types and mutation sites were analyzed on line． Ｒesults From 2010 to 2015，viral load detection was conducted in 1 693 HIV infected persons; the viral loads in 465 infected persons was ≥1 000 cps/ml． Drug resistance monitoring was conducted in these 465 infected persons and positive PCＲ amplification was obtained in 249． Drug resistance was developed in 120 ( 7. 09%) ． Patients were mainly resistant to nucleoside analog reverse transcriptase inhibitors ( NＲTIs) and non－nucleoside analog reverse transcriptase inhibitors ( NNＲTIs) ; cross resistance was serious; the number of drug－resistant patients was the largest in Cuiping District． Conclusion HIV drug resistance epidemic situation is in a moderately state in Yibin． From 2010 to 2015， the HIV drug resistance population in Yibin was increasing year by year． HIV infected persons in Yibin are mainly resistant to NＲTIs and NNＲTIs， the cross resistance condition is serious and the resistance to NNＲTIs is more serious． The distribution of drug resistance patients in different districts and counties of Yibin is not homogenous，and the number of drug－resistant patients is the largest in Cuiping District．
Key words human immunodeficiency virus; drug resistance; highly active antiretroviral therapy