| ObjectiveIn this study,we investigated drug resistance of patients who infected with HIV/AIDS from 2014 to 2015 and understand the status of drug resistance in antiviral treatment population in Shandong Province,aim to provide a reference for improving the quality of antiviral therapy and patient'slife,prolonging the overall survival of patients.MethodsThis study adopted a combination of quantitative and qualitative research to investigate drug resistance and its influencing factors in HIV-infected/AIDS patients.Quantitative Study:We conduct regular follow-up work on HIV-infected/AIDS patients in Shandong Province who receive HAART for more than 6 months and then complete viral load testing every year.The drug resistance rate was calculated based on the detection of drug resistance and viral load test results.From 2014 to 2015 in Shandong province,a total of 4,265 HIV-infected/AIDSpatients had viral load testing.After gene detection,there were 281 patients who were older than 15years of age and VL>1 000 copies/ml were identified as drug resistance.According to the case-control study 1:2 matching design,we predicted 170 patients in the resistant group and340 patients in the non-resistance group.Using simple random sampling method,we select165drug-resistant HIV-infected/AIDS patients as drug-resistant group,326 patients who lived in the same counties(cities,districts),the same gender,age difference less than 5 years old,no drug resistance were consider as non-resistance group.Researchers entered the village to conduct face-to-face investigations.This survey included general demographic data,infection status,treatment status,willingness to take medicine,laboratory testing indicators,immunological indicators and virological indicators.Using EpiData 3.1 to set up a database.Two individuals entered the data and checked the consistency of the database until the database was completely consistent.SPSS 22.0 statistical software was used for statistical analysis of data and the single factor?~2test was used for the antiviral treatment resistance factors.Single factor analysis showed that statistically significant(P<0.10)variables were included in the multivariate logistic regression model for analysis.Qualitative research:We select 20 highly qualified and representative antiviral patients and 5 local staff responsible for anti-viral treatment as the investigate subjects.After agreement of these people,we began depth interviews.Detailed recordings were made using recording equipment and paper pens.Results1.The drug resistance rate in Shandong Province from 2014 to 2015 was 6.6%.281 cases of drug-resistant HIV-infected persons/AIDS patients were mainly male in Shandong Province,accounting for 77.9%;the average age were(39.14±10.74)years;the marital status were mainly married or cohabitation,accounting for 55.5%(145/281);CD4T Lymphocytes are concentrated between 201 and 350;the majority of patients are treated within two years;heterosexual transmission and homosexual transmission are the main transmission routes,accounting for 42.0%(118/281)and 41.6%(117/281)respectively.2.According to the detection results of drug-resistant genotypes,281 cases of drug-resistant HIV-infected persons/AIDS patients were mainly resistant to NNRTIs,accounting for 62.6%;127 cases showed double resistance to NRTIs and NNRTIs.The NRTIs are mainly resistant to didanosine(DDI),abacavir(ABC),lamivudine(3TC)and emtricitabine(FTC).The NNRTIs are mainly resistant to efavirenz(EFV)and nevirapine(NVP).The virus subtypes were dominated by CRF01_AE type,accounting for 52.3%(147/281),followed by B subtype 37.0%(104/281),and the C subtype accounted for a small proportion.M184V is the major drug resistance mutation site for NRTIs,accounting for75.9%.K103N and G190A are common mutation sites for NNRTIs,accounting for 27.3%and2.16%respectively.The mutation sites of PIs appeared were M46I,L33F and I47V,accounting for 42.8%,2.9%and 14.3%respectively.3.A total of 491 cases were investigated in a case-control study,of which 165 were resistant group and 326 were non-resistance group.The average age were(38.11±10.08)years old.The two groups were not comparable in age,gender,marital status,nationality,and education level,the difference was not statistically significant(P>0.05).Univariate analysis showed that the drug resistance group and non-drug resistance group were significant difference(P<0.05)in baseline CD4 T lymphocytes,whether to change drugs,distance from the drug taking point,whether it's convenient for taking drug,who received the drug in the last month,forgot to take drugs,the proportion of forgetting to take antiviral drugs.Multivariate analysis showed that forgot to take drugs,change drugs,the proportion of forgetting to take antiviral drugs more than 25%were risk factors leading to drug resistant.The taking medicine by himselfis a protective factor for drug resistance.4.The forgetting was mainly reason for forgetting to take antiviral drugs,accounting for53.9%.The main type of side effects were nausea and vomiting,accounting for 41.7%;Followed by rash,central nervous system symptoms(such as dizziness)and abnormal liver function,were 23.5%(48/204),13.7%(28/204))and 13.2%(27/204)respectively.5.Qualitative survey:We select 20 highly qualified and representative antiviral patients and 5 local staff responsible for anti-viral treatment as the investigate subjects.The educational level of the antiviral patients were mainly junior high school,accounting for50.0%(10/20).The promotion work and follow-up visits are significance.HIV-infected/AIDS patients can basically grasp the basic knowledge of HIV transmission and antiviral therapy,accounting for 70.0%(14/20).Nearly half of the infections are due to same-sex sexual transmission,accounting for 45.0%(9/20).The side effects of medications were mainly allergy,rash,gastrointestinal reactions,and central nervous system symptoms ect.The reason for forgetting to take antiviral drugs were missing and do not thinkthat heneed to take medicine because of feeling healthy.The medical staff interviewed all stated that there was a great disparity in the amount of work and staff in the work.Conclusion1.The overall level of drug resistance in Shandong Province was lower than others.The virus subtypes were mainly CRF01_AE type,most of which are resistant to NNRTIs,and M184V is the main drug resistance mutation site of NRTIs.2.There are many factors that affect drug resistance.Poor adherence to medication and non-self drug delivery are the main risk factors for drug resistance.Compliance education and intervention in patients with antiviral therapy should be strengthened to ensure the effectiveness of antiviral treatment.3.The proportion of patients who forgettingto take drugs due to forgetting was high.Most subjects had adverse reactions after taking the drugs,mainly were gastrointestinal symptoms,central nervous system symptoms,and allergic reactions.4.The Center for Disease Control and Prevention needs to implement a working model dedicated to antiretroviral therapy by dedicated personnel,rational allocation of medical resources,and efforts to provide patients with better and more efficient medical services. |
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