目的 探讨整合酶抑制剂(integrase strand transfer inhibitors,INSTIs)耐药艾滋病患者临床表现、诊断、治疗和预后,并分析耐药产生原因及预防措施.方法 报道1例艾滋病病例INSTIs一、二代药物均耐药,并从病例出发分析耐药产生原因.结果 该病例首次耐药检测提示蛋白酶区域无突变位点,核苷酸逆转录酶、非核苷酸逆转录酶部分位点突变,更换为含INSTIs治疗方案后仍旧抗病毒失败,再行耐药检测发现患者对INSTIs耐药,调整方案后抗病毒治疗成功.该患者为晚发现患者,治疗期间擅自停药以及当时INSTIs耐药检测未纳入常规耐药检测等情况,导致了患者对INSTIs严重耐药.该病例中整合酶区域的Q148R突变在INSTIs耐药中起关键作用.结论 应对艾滋病患者加强宣教、护理关怀和跟踪随访,增加患者服药依从性.在整合酶抑制剂应用越来越广泛的今天,建议将整合酶抑制剂药物的耐药检测纳入常规耐药检测中,以便全面掌握患者的耐药情况,减少耐药的发生,提高患者的生存率和生存质量.
A case analysis of a rare HIV patient with integrase strand transfer inhibitor resistance
Objective To investigate the clinical manifestations,diagnosis,treatment,and prognosis of an AIDS patient resistant to integrase inhibitors (INSTIs) to integrase strand transfer inhibitors (INSTIs),and to analyze the causes of drug resistance and preventive approaches. Methods A case of an AIDS patient resistant to both first-and second-generation INSTIs was reported,with an analysis of the causes of resistance based on the case. Results In this case,the initial drug resistance test for this patient indicated no mutation sites in the protease region,with some mutation sites in nucleotide reverse transcriptase and non-nucleotide reverse transcriptase. After changing the treatment plan to one containing INSTIs,the antiviral treatment still failed,and then the re-drug resistance test found that the patient was resistant to INSTIs,then after adjusting the regimen,the antiviral treatment was successful. The late diagnosis of this patient,the discontinuation of medication during treatment,and the fact that the testing for resistance to INSTIs was not included in routine resistance testing at that time contributed to the patient's significant resistance to INSTIs. The Q148R mutation in the integrase region played a key role in INSTIs resistance in this case. Conclusions AIDS patients should be strengthened with awareness-raising,nursing care,and follow-up to increase the patient's adherence to medication. Nowadays,with the increasing use of integrase inhibitors,it is recommended to include INSTI resistance testing in routine resistance tests to fully grasp the drug resistance of patients,reduce the occurrence of drug resistance,and improve the survival rate and quality of life of patients.
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