| BACKGROUNDAs AIDS epidemic has become one of the most serious global public health event, AIDS patients need urgent medical treatment.In 1995,HAART was used in AIDS patients,which made the anti-viral treatment of AIDS enter a new stage.HAART can effectively suppress virus replication and rebuild the immune function of HIV-infected people,and also can improve clinical symptoms and reduce mortality of patients, however,HAART can not clear the virus completely.Patients need to take medicine for life.Cross-resistance and multi-drug resistance may appear with the choices of anti-HIV -1 drugs.With earlier carring out of Anti-retroviral therapy and more patients treated in developed countries,more cases were reported by them.However,in our country, due to technology and ecnomic factors,large-scale Anti-retroviral therapy was developed much later.Therefore,the research and investagations of drug resistance were much less correspondingly.In our study,we investagated the factors which may affect the drug resistance,virus depression failure and CD4 cell counting to provide the scientific data and guide for the anti-retroviral therapy in our country.As a developing country with limited resources,China has largest base of HIV-infected people,so all patients with antiviral therapy received the testing of drug resistance is not possible,wich may be faced with high input and the feasibility of poor by financial and manpower constraints. Therefor,this paper attempt to use the early warning monitoring system by WHO recommended to assessment the level of drug resistance,and validate the feasibility of early warning monitoring system for HIV drug resistance in China.This research in this area is blank in China now. OBJECTIVE1,To understand about that the epidemic profile of HIV drug resistance among ARV-treated AIDS patients of first-line regimen,and risk factors associated with HIV drug resistance in China.2,To understand the factors associated with viral suppression among ARV-treated AIDS patients of first-line regimen in China.3,To understand the factors associated with CD4 cell level among ARV-treated AIDS patients of first-line regimen in China.4,To validate the feasibility of early warning monitoring system for HIV drug resistance of WHO recommended in China.METHODS1,A cross-sectional study was conducted among 28 provinces in China,in addition to Guizhou,Ningxia and Tibet from August 2006 to March 2007.All standard participants underwent a structured interview,and serum samples were collected.The questionnaire including demographics,situation of treatment,will of the medication,and situation of the taking.Laboratory test including immunology indicators(CD4 cell counts), virology indicators(viral load) and drug resistance indicators(genotype).2,The situation and the effects of the free ART programme were analyzed using univariate and Chi-square tests and multivariate Logistic regression model;Drug resistance prevalence and association were analyzed using Chi-square tests and multivariate Logistic regression model;Viral suppression and CD4 cell counts association were analyzed using Chi-square tests and multivariate Logistic regression model.3,2 persons separately input data into Epidata 3.0database and made consistency check.Statistic analysis used SAS 9.1 software.4,In September 2007,we chosed Yingzhou district,Funan county,Queshan county and Weishi county area pilot counties.We colleced the data about early warning indicators for durg resistance of WHO recommended.5,Based on the data collected,we are strictly in accordance with the terms indicator of HIV drug resistance early warning indicators.The experts of national resistance working group screen and score these indicators.According to the results of drug resistance in the same period,we can validate the feasibility of early warning system for HIV drug resistance of WHO recommended in China.RESULT1,This survey investigated 2689 people,which accounted for 10.5%of the number of treatment patients in the same period in our country.The number of initial early first-line(AZT/DDI/NVP and D4T/DDI/NV) treatment patients are 1062,which accounted for 39.5%of the total number of survey.The number of the late first -line(AZT/3TC/NVP,D4T/3TC/NVP,AZT/3TC/EFV and D4T/3TC/EFV) treatment patients are 1165,which accounted for 37.2%of the total number of survey.The other 462 patients did not use the national standard first-line treatment;2,The rate of viral suppressed is 65.6%,the rate of resistant mutation in treated population is18.3%,and the rate of resistance mutation is 57.3%in virus suppress failure population.The rate of resistant mutation is 29.6%in patients who received early first-line ART regimen,the rate of resistance mutation is 8.4%in patients who received late first-line ART regimen.The rate of resistant mutation of the late first-line regimen was lower than the early first-line regimen by the treatment time of post-stratification(P＜0.05).3,In multivariate logistic regression model,fixed income,not miss drug last month,use D4T+DDI+NVP regimen were significantly associated with drug resistance of early first-line ART regimen.Female,more than 40 years old,pay drugs by CDC or hospital at the county directly,the rate of take antiviral drugs on time are greater than 90%last month were Significantly associated with drug resistance of late first-line ART regimen.4,In multivariate logistic regression model,fixed income,get drugs from CDC or hospital freely,the rate of take antiviral drugs on time are greater than 90%last month, did not stop treatment were Significantly associated with viral suppression failure of early first-line ART regimen.Female,fixed partner,not miss drug last 3days,did not stop treatment were significantly associated with viral suppression failure of late first-line ART regimen.5,In multivariate logistic regression model,fixed partner,the rate of take antiviral drugs on time are greater than 90%last month,treatment more than 24 months,Viral load≤1000 copies/ml were Significantly associated with CD4 cell counts＜200 of early first-line ART regimen.Female,treatment time more than 12 months and 12～24 months, replaced ART regimen were significantly associated with CD4 cell counts＜200 of late first-line ART regimen.6,The level of HIV drug resistance of 4 pilot counties are at low to moderate level,which are in line with the results of HIV drug resistance among the monitoring in the same period.CONCLUSION1,For the early first-line ART regimen,drug resistance mutations in patients who had no fixed income,missed drug in last month,used AZT+DDI+NV regimen had significantly higher than those patients who didn't do it;For the late first-line ART regimen,drug resistance mutations in patients who are male,younger than 40 years old, got drug from rural hospitals,taking antiviral drugs on time rate are lower than 90% in last month were significantly higher than those patients who didn't do it.2,For the early first-line ART regimen,viral suppression failure in patients who had not fixed income,got drug from rural hospitals,taked antiviral drugs on time rate are lower than 90%in last month,and stopped treatment were significantly higher than those patients who didn't do it;For the late first-line ART regimen,viral suppression failure in patients who are male,without fixed partner,missing drug in last 3days,and stopped treatment were significantly higher than those patients who didn't do it.3,For the early first-line ART regimen,the rate of CD4 cell counts＜200 in patients who had fixed partner,taking antiviral drugs on time rate are higher than 90%in last month,received ART treatment more than 24 months,and with viral load of less than 1,000 were significantly lower than those patients who didn't do it;For the late first-line ART regimen:The rate of CD4 cell counts＜200 in patients who are female, received ART treatment more than 24 months,changed ART regimen were significantly lower than those patients who didn't do it.4,The level of HIV drug resistance of 4 pilot counties are at low to moderate level,which are in line with the results of HIV drug resistance among the monitoring in the same period.That show early warning system for HIV drug resistance is feasible in our country.Therefore,it is necessary to provide effective society-supporting system for the AIDS patients to improve the medication compliance effectively,and to make drugs to give full play,in order to reduce the drug resistance rate and to improve the antiviral therapeutic effect.This paper use the early warning monitoring system by WHO recommended to assessment the level of drug resistance,the level of HIV drug resistance of 4 pilot counties are at low to moderate level,which are in line with the results of HIV drug resistance among the monitoring in the same period.That show early warning system for HIV drug resistance is feasible in our country,but it still need to adjust repeatedly to worked out early warning monitoring system for the national conditions of China's popular resistance eventually. |
PDF Full Text Request