中国未接受抗病毒治疗的人类免疫缺陷病毒/获得性免疫缺陷综合征（HIV/AIDS）人群HIV原发耐药的Meta分析

doi:10.3969/j.issn.1671-167X.2015.03.020

摘要/Abstract

摘要： 目的：了解中国未接受抗逆转录病毒治疗的人类免疫缺陷病毒/获得性免疫缺陷综合征（human immunodeficiency virus infection and acquired immune deficiency syndrome，HIV/AIDS）人群HIV原发耐药水平。方法：检索5个数据库：《中国生物医学文献数据库》(Chinese BioMedical Literature Database, CBM)、《中国期刊全文数据库》(Chinese Journal Full-text Database, CNKI)、《中文科技期刊数据库-维普》(Chinese Science-Technology Journal Database, VIP)、万方数据知识服务平台及PubMed数据库，提取HIV耐药数据，使用随机效应模型对数据进行合并，对采样时间、采样地点、人群特征（平均年龄及感染状态）、样本量进行亚组分析。结果：共纳入76篇文献（中文46篇，英文30篇），中国未接受抗病毒治疗的HIV/AIDS人群HIV原发整体耐药率、非核苷类反转录酶抑制剂（non-nucleoside reverse transcriptase inhibitor，NNRTI）耐药率、核苷类反转录酶抑制剂（nucleoside reverse transcriptase inhibitor，NRTI）耐药率、蛋白酶抑制剂（protease inhibitor，PI）耐药率分别为4.7% (95%CI: 4.0%~5.4%)、2.3% (95%CI: 1.8%~2.8%)、1.8% (95%CI: 1.3%~2.3%)、1.4% (95%CI: 1.1%~1.8%)。上述4类耐药率均是2007年之前高于之后，且都存在显著地区差异（P<0.05），其中，中南及西南地区整体耐药率均高于5%。平均年龄、感染状态亚组中，组间差异较为复杂，其中小于25岁及新发、新确认组其整体耐药率低于25岁以上及非新发、新确认组。样本量<100的亚组，各耐药率均高于样本量≥100的亚组，且差异都有统计学意义（P<0.05）。结论：中国HIV/AIDS人群HIV病毒原发总耐药率为4.7%，仍处于低流行状态，但已接近WHO提出的5%中度耐药警戒线，中南及西南地区整体耐药率已经超过该警戒线，应进一步加强监测。

关键词: 获得性免疫缺陷综合征, HIV感染, 抗HIV药, 抗药性, 病毒, Meta分析

Abstract: Objective：To estimate the prevalence of antiretroviral drug resistance in treatment-naive individuals with human immunodeficiency virus (HIV) in China. Methods: Five electronic databases ［Chinese BioMedical Literature Database (CBM), Chinese Journal Full-text Database (CNKI), Chinese ScienceTechnology Journal Database (VIP), Wanfang Data, and PubMed］ were searched for studies of HIV drug resistance in untreated individuals. Drug resistance data were abstracted then pooled using the random effect model. Subgroup analysis was done across sampling time, location, study population (mean age and infection status), and sample size. Results: Seventy-six studies were included for our meta-analysis (46 in Chinese, 30 in English). The pooled rates of drug resistance to total, to non-nucleoside reverse transcriptase inhibitor (NNRTI), to nucleoside reverse transcriptase inhibitor (NRTI), and to protease inhibitor (PI) were 4.7% (95%CI：4.0%-5.4%), 2.3% (95%CI：1.8%-2.8%), 1.8% (95%CI：1.3%-2.3%), and 1.4% (95%CI：1.1%-1.8%), respectively. All the rates before 2007 were higher than those for 2008 or later. Meanwhile, significant differences were found in the sample areas (P<0.05), in which, the rates in South-central and Southwest were both higher than 5%. The difference was complex between mean age and infection status subgroup, and we found the total prevalence in the group under 25 years and the newly infected, and confirmed group was lower than in the others. For sample size, all the rates in the group under 100 samples were higher than in the others, and the difference was significant (P<0.05). Conclusion: The prevalence of HIV primary drug resistance in China was 4.7%, which stayed low, but was also close to the line set by WHO. Enhanced surveillance for drug resistance is necessary in high epidemic areas including the South-central and Southwest China whose prevalence has crossed the line.

Key words: Acquired immunodeficiency syndrome, HIV infections, Anti-HIV agents, Drug resistance,viral, Meta-analysis

中图分类号:

R521.91

刘大锦, 冯孟贤, 刘民. 中国未接受抗病毒治疗的人类免疫缺陷病毒/获得性免疫缺陷综合征（HIV/AIDS）人群HIV原发耐药的Meta分析[J]. 北京大学学报（医学版）, 2015, 47(3): 474-482.

LIU Da-Jin, FENG Meng-Xian, LIU Min. Primary drug resistance of human immunodeficiency virus (HIV)among the treatment-naive individuals with HIV in China: a meta-analysis[J]. Journal of Peking University(Health Sciences), 2015, 47(3): 474-482.

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