Effect and drug resistance variation of second-line antiretroviral therapy among patients with acquired immune deficiency syndrome in a county of Henan Province

doi:10.3877/cma.j.issn.1674-1358.2017.04.004

Abstract

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 second-line 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 second-line, 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 second-line 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.

Key words: Acquired immune deficiency syndrome, Highly active antiretroviral therapy, Drug resistance, Second-line therapy

Mingquan Shang, Min Zhang, Hong Shang. Effect and drug resistance variation of second-line antiretroviral therapy among patients with acquired immune deficiency syndrome in a county of Henan Province[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(04): 330-334.

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References 24

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变量		例数
性别[例（%）]
	男	43（61.2）
	女	22（32.8）
CD4⁺ T细胞计数[例（%）]
	< 200个/μl	32（49.2）
	≥ 200个/μl、< 350个/μl	25（38.5）
	≥ 350个/μl	8（12.3）
CD4⁺ T细胞计数均值（ ± s）		212.00 ± 137.056
病毒载量（拷贝/ml）
	< 400拷贝/ml	4（6.2）
	≥ 400拷贝/ml、< 10 000拷贝/ml	16（34.6）
	≥ 10 000拷贝/ml	45（69.2）
病毒载量均值（log）		4.51 ± 1.076
耐药患者[例（%）]		51（78.5）
	PI	0（0.0）
	NRTI	43（66.2）
	NNRTI	51（78.5）
获得序列		62（95.4）

变量		例数
性别[例（%）]
	男	43（61.2）
	女	22（32.8）
CD4⁺ T细胞计数[例（%）]
	< 200个/μl	32（49.2）
	≥ 200个/μl、< 350个/μl	25（38.5）
	≥ 350个/μl	8（12.3）
CD4⁺ T细胞计数均值（ ± s）		212.00 ± 137.056
病毒载量（拷贝/ml）
	< 400拷贝/ml	4（6.2）
	≥ 400拷贝/ml、< 10 000拷贝/ml	16（34.6）
	≥ 10 000拷贝/ml	45（69.2）
病毒载量均值（log）		4.51 ± 1.076
耐药患者[例（%）]		51（78.5）
	PI	0（0.0）
	NRTI	43（66.2）
	NNRTI	51（78.5）
获得序列		62（95.4）

组别	CD4⁺ T细胞均值（ ± s，个⁄μl）	CD4⁺ T细胞计数[例（%）]		病毒载量均值（ ± s，log）	病毒载量[例（%）]
组别	CD4⁺ T细胞均值（ ± s，个⁄μl）	< 200个/μl	≥ 200个/μl		< 400拷贝/ml	≥ 400拷贝/ml
治疗前	212.00 ± 137.06	32（49.2）	33（50.8）	4.51 ± 1.08	4（6.2）	61（93.8）
6个月	247.89 ± 142.78	18（34.6）	26（50.0）	2.43 ± 1.42	35（67.3）	17（32.7）
12个月	291.65 ± 142.76	14（26.4）	39（73.6）	2.17 ± 1.61	33（62.3）	20（37.7）
^a统计量	t =-1.185	χ² = 0.732		t = 6.780	χ² = 48.617
^aP值	0.239	> 0.050		< 0.001	< 0.001
^b统计量	t =-2.417	χ² = 6.389		t = 2.343	χ² = 42.704
^bP值	0.017	0.011		0.021	< 0.001

组别	CD4⁺ T细胞均值（ ± s，个⁄μl）	CD4⁺ T细胞计数[例（%）]		病毒载量均值（ ± s，log）	病毒载量[例（%）]
组别	CD4⁺ T细胞均值（ ± s，个⁄μl）	< 200个/μl	≥ 200个/μl		< 400拷贝/ml	≥ 400拷贝/ml
治疗前	212.00 ± 137.06	32（49.2）	33（50.8）	4.51 ± 1.08	4（6.2）	61（93.8）
6个月	247.89 ± 142.78	18（34.6）	26（50.0）	2.43 ± 1.42	35（67.3）	17（32.7）
12个月	291.65 ± 142.76	14（26.4）	39（73.6）	2.17 ± 1.61	33（62.3）	20（37.7）
^a统计量	t =-1.185	χ² = 0.732		t = 6.780	χ² = 48.617
^aP值	0.239	> 0.050		< 0.001	< 0.001
^b统计量	t =-2.417	χ² = 6.389		t = 2.343	χ² = 42.704
^bP值	0.017	0.011		0.021	< 0.001

相关因素		OR（95%CI）
性别（女）		1.19（0.34～4.18）
年龄（> 45岁）		2.11（0.64～6.95）
HAART > 3年		0.12（0.01～1.49）
CD4⁺ T < 100个/μl		5.14（0.99～26.71）
CD4⁺ T ≥ 100、CD4⁺ T < 200个/μl		1.72（0.35～8.48）
CD4⁺ T ≥ 200个/ul		1.0
二线方案起始VL > 10 000拷贝/ml		3.36（0.66～17.21）
二线方案更换NRTI药物数量
	1个NRTI	1.31（0.13～13.74）
	2个NRTI	0.76（0.07～7.98）

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