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Objective To analyze HIV-1 drug resistance mutations and relative factors in the patients infected with HIV-1 through different routes after having received highly active anti-retroviral therapy (HAART) in Hebei province. Methods Plasma samples were collected from patients who were infected with HIV through different routes. Detection of HIV-1 RNA pol region was carried out by detection of genotype, and HIV drug resistance mutations were analyzed. Results Among 266 patients, 157 developed mutation. The rate of the drug-resistance was 59.0%. Among 266 patients, drug-resistance rates were ranked from high to low as follows: NVP 65.8% (175/266), 3TC 41.7% (111/266), FTC 41.7% (111/266), EFV 30.1% (80/266), DDI 5.6% (15/266), D4T 4.1% (11/266), AZT 3.0% (8/266) and ABC 3.0% (8/266). The drug-resistance rate of blood infection patients was much higher than that of sexual and mother-to-child transmission ones, but χ2-test indicated that the differences in main mutation sites (Y181C, K103N, V108I, K101E in NNRTIS coding region, M184V/I, M41L, T215F, T215Y in NRTIs coding region and A71V/ T, L10I, M46L, Q58E in PIs coding region) were not statistically significant (P>0.05) among the patients infected through three routes. The results of OR value and the 95% confidence interval (CI) indicated that age, infection routes, CD4+ cell count and initial therapeutic plan had a significant relevance to HIV-1 drug resistance mutation (P<0.05). Conclusion Timely monitor of CD4+ cell number, viral load and drug resistance, and evaluation of progression of AIDS, are essential to minimize the influence of related factors on drug resistance, and to renew the therapeutic plan in time during HAART in order to enhance the therapeutic effects.
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Objective To study the characteristic of HIV-1 gene mutation in HIV/AIDS patients infected by blood transfusion, and analyze the resistance to anti-HIV drugs. Methods Plasma samples were collected from 37 HIV/AIDS patients infected by blood transfusion for extraction of HIV-1 RNA. The gene fragments of HIV pol domain were amplified by RT-PCR and nested-PCR, and the electrophoresis positive products were sequenced. The sequencing result was landed to the website http:// HIV-ldb.stanford.edu to analyze the drug resistance mutations. Results Drug resistance mutations were found in 20 patients, including 19 cases of virological or immunological failure. Mutation of gene locus V32AV of protease inhibitors (Pis) occurred in 3 patients during the treatment, but it did not cause the drug resistance of Pis. Mutation of the coding regions of reverse transcriptase was found in 23 patients, including M184V, TAMs, Q151M complexus, K103N, Y181C and so on. Of the 23 patients mentioned above, the HIV-1 gene mutation induced the resistance to reverse transcriptase inhibitors (RTIs) in 20 patients, and the mutation rate of RTIs was 54.05% (20/37). Conclusion The drug resistance rate of HIV-1 in patients infected by blood transfusion may be high for antiviral therapy, so the drug resistance of HIV-1 should be monitored and treatment plan should be adjusted timely.
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Objective To study the natural history of AIDS,caused by blood transfusion.Methods All HIV infections and AIDS patients were from Hebei province,including those infected through blood transfusion around 1995,that were identified as through general census of former commercial plasma donors (FCPDs).Among those objects being observed during the incubation period,354 had HIV infections( including 142 cases infected via plasmapheresis and 212 cases caused by transfusion) but had not been treated by HAART before the onset of disease.Objects being observed during the survival period,141 were AIDS patients (including 57 cases infected via plasmapheresis and 84 cases causes by transfusion) but had not been treated by HAART before and after the onset of disease.All infectors and AIDS patients were under follow-up on the progress of illness or death,respectively.Results By December 31,2010,the cumulative incidence among HIV infections was 88.70％ ( 314/354),with the incidence density as 9.14/100 person-years ( 314/3435.75 )and the median incubation period was 113 months.Of 142 HIV infections in the blood donation group and 212 infections in the blood transfusion group,the incubation periods were 112 months and 115 months,respectively.All of the 141 patients died 34 months after the onset,with the death-strength as 204.70/100 person-years (141/68.88) and the period of survival was 4 months.Among those 57 FCPDs infections,they were all died 24 months after the onset,with the death-strength as 250.66/100 person-years (57/22.74) and the survival was 3 months.The other 84 infections who were blood recipients,all died 34 months after the onset,with the death-strength as 182.05/100 person-years (84/ 46.14) and the survival was 4 months.Conclusion Through this study,we noticed that the natural history of all the AIDS patients was caused by blood transmission.It was important to evaluate the natural history of HIV epidemics among both FCPDs and blood recipients,occurred before and after 1995.
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<p><b>OBJECTIVE</b>To examine the state of incubation period and survival time of former commercial plasma donors (FCPDs) infected with HIV.</p><p><b>METHODS</b>All objects infected with HIV were from Hebei province and found from general investigation for FCPDs in 1995. The infector cohort by 142 cases was used to estimate incubation period. In the infector cohort, the time which infectors entered the cohort was their infection time, which was the middle value of the origin date, which was January 1, 1995. The onset of AIDS was defined as an outcome event. End point of observation was Dec 31, 2010. There were 192 months in all from beginning to end. The AIDS cohort by 57 cases was used to estimate the survival of the patients. In the patient cohort, the time of AIDS onset was defined as the time entering the cohort, and death of AIDS was defined as an outcome event. The cumulative incidence ratio, cumulative mortality, illness intensity and mortality intensity were analyzed through Kaplan-Meier.</p><p><b>RESULTS</b>During the observation period, 123 cases of 142 infectors developed into AIDS, the cumulative incidence was 86.42% (123/142) and the intensity was 8.53/100 person-years and the median time of incubation period was 112.0 months (95%CI: 108.8 - 115.2). The death dates of 57 patients were from 1 to 24 months after onset. The cumulative mortality was 100%, and the intensity was 250.66/100 person-years and the median survival time was 3.0 months (95%CI: 1.8 - 4.2). It was estimated that the median time was 115.0 months (9.6 years) from infection to death.</p><p><b>CONCLUSION</b>The median times of incubation and median survival time were 112.0 and 3.0 months, respectively.</p>
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Adult , Female , Humans , Male , Middle Aged , Young Adult , Blood Donors , Cohort Studies , HIV , Physiology , HIV Infections , Epidemiology , Mortality , Virology , Incidence , Retrospective Studies , Survival Rate , Virus LatencyABSTRACT
Objective To elucidate the prevalence and the mutation pattern of N348I that related to the resistance seen in the AIDS patients, in China. Methods Partial pol gene of HIV-1 comprising of full protease (PR) and reverse transeriptase (RT) was obtained from plasma samples of therapy-failure individuals (n=614) and therapy-naive individuals (n=619) by using reverse transcription polymerase chain reaction(RT-PCR). 1233 sequences were then submitted to the HIV-1 drug resistance database of the Stanford University to analyze the prevalence and the emergence pattern of N348I. Results The prevalence of N348I was 6.5％ in the therapy-failure patients and 0.8％ in the naive individuals, respectively. The prevalence of N348I was more popular among those patients whose ART regimens containing zidovudine (AZT or ZDV) than those without AZT in regimens( 14.1％ vs. 4.7％, x2=10.21, P＜0.01 ). N3481 always emerged, and combined with others mutations among patients of ART, whose frequencies were: 85.0％ in combination with thymidine analog mutations (TAMs) and 52.5％ with M184V/I, respectively. Conclusion N348I was somehow prevalent in the therapy-failure patients when using the first-line antiretroviral drugs,and it emerged as unique patterns. This study laid the ground in improving the techaology of drug resistance genotypes detection and providing theoretical basis to study the mechanism of resistance and the law of molecular evolution.
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<p><b>OBJECTIVE</b>To study epidemiological features of HIV infection after blood transfusion and the situation of transmission among members of family.</p><p><b>METHODS</b>The persons infected with HIV through blood transfusion and their intrafamilial transmission in some city were analyzed and testing methods of ELISA, Western-blot, RT-PCR and subtype analyzing were used. The whole surveillance data came from residents investigation around problem medical centres and HIV monitoring network around Hebei province.</p><p><b>RESULTS</b>173 people infected with HIV after blood transfusion in some city, including 89 cases found in hospital and 84 cases in CDC, accounted for 68.7% (173/252) of all of infected persons by blood transfusion in Hebei province. The rate of intrafamilial transmission, spousal transmission and mother-to-child transmission((MTCT) were 32.0% (49/153),17.0% (26/153) and 32.7% (32/98), respectively. Most of persons infected with HIV were youth among who the female were more than the male. Childbearing and women's ailments were the main cause of blood transfusion from 1990 to 1999, and traumatism surgery took second place. Infected persons by HIV blood, whose time to diagnostic were the year from 1999 to 2009, spread over Kangtai hospital and other hospital which accounted for 45.1% (78/173) and 42.2% (73/173), respectively. The genetype of all patients were B' subtype.</p><p><b>CONCLUSION</b>The medical centers at the grass-roots level in some city resulted in outbreak of infected persons by HIV blood because of having no screening test antibody of HIV for liid blood donors.</p>