Analysis Of The Antiviral Effect Of Integrase Inhibitors In HIV-1-Infected Patients

Objective To compare the antiviral treatment effect of HIV-1 infected patients using free national drugs for one year with HIV-1 infected patients using integrase inhibitors for one year in Hunan Province,to assess the efficacy of using INIs.To analyze the reasons for the virologic failure of INIs,to detect mutations in the integrase gene of HIV virus in patients who failed antiviral treatment of INIs,and to analyze the causes of drug resistance of INIs to provide a reference basis for antiviral treatment of AIDS.Methods To obtain information on the demographic characteristics and relevant clinical data of HIV-1-infected patients using INIs drug treatment for one year and HIV-1-infected patients using free national drug treatment for one year in Hunan Province during the period of January 1,2020-December 31,2020 from the National AIDS Control Information System.The genes of HIV strains were obtained and sequenced,and uploaded to the Stanford University HIV drug resistance database for interpretation of gene resistance mutations.The differences in the efficacy of the two therapies were analyzed using wilcoxon rank sum test andχ²test,and the therapeutic effect of INIs antiviral and its influencing factors were analyzed byχ² test,Fisher test and binary logistic regression method.To describe and analyze the mutations and resistance rates of integrase gene.Results The viral load after treatment was lower in the INIs group than in the free drug group,and the difference was statistically significant（Z=-3.482,P<0.001）;the ratio of CD₄⁺T lymphocyte count after treatment to before treatment was higher in the INIs group than in the free drug group,and the difference was statistically significant（Z=-8.347,P<0.001）;the ALT value in the INIs group was lower than in the free drug group,and the difference was statistically significant（Z=-8.888,P<0.001）.In the INIs group,12 cases（2.9%）of virologic failure occurred.The rate of virologic failure was lower in patients with good medication adherence（2.3%）than in those with poor medication adherence（15.8%）,with a statistically significant difference（P=0.014）;multifactorial analysis showed that the risk of virologic failure was 11.664 times higher in patients with poor medication adherence than in those with good medication adherence（OR=11.664,95%CI:2.305～59.012）.In the INIs group,there was one case（0.2%）of resistance to INIs with resistance mutations T66I,G118R,E138K,and high resistance to all 5 classes of INIs;the patient with INIs resistance mutation had a low baseline CD₄⁺T lymphocyte count（<200cells/μL）and poor compliance with medication.Conclusions The antiviral effect of INIs treatment was better than that of free national drugs;poor medication compliance was one of the risk factors for virologic failure in patients using INIs;the incidence of integrase resistance in patients using INIs in Hunan Province was at a lower level,but once resistance mutations occurred there was a possibility of high resistance to all INIs,so it was necessary to carry out INIs resistance testing.