艾滋病抗病毒治療的耐藥檢測(cè)方法(參考版)
2025-05-29 18:19本頁面
【正文】 Nucleoside Resistance Mutations ? Zidovudine 41, 67, 70, 210, 215, 219 (TAMs) ? Didanosine 65, 74, 75, 184 ? Zalcitabine 65, 69, 74, 184 ? Stavudine 41, 67, 70, 75, 210, 215, 219(TAMs) ? Lamivudine 184 ? Abacavir 41, 65, 67, 70, 74, 115, 184, 210, 215, 219 Multinucleoside Resistance ? Multiple TAMs 41, 67, 70, 210, 215, 219 ? 69 insertion plex 41, 62, 67, 69, 70, 210, 215, 219 ? 151 plex 62, 75, 77, 116, 151 NNRTI Resistance Mutations ? Nevirapine 100, 103, 106, 108, 181, 188, 190, 230 ? Delavirdine 103, 181, 230, 236 ? Efavirenz 100, 103, 108, 188L, 190, 225, 230 Protease Resistance Mutations ? Indinavir 10, 20, 24, 46, 63, 64, 82, 84, 90 ? Nelfinavir 30, 35, 36, 46, 71, 84, 88, 90 ? Ritonavir 8, 10, 20, 33, 36, 54, 63, 71, 82, 84, 90 ? Saquinavir 10, 24, 30, 46, 48, 54, 63, 64, 71, 73, 77, 81, 84, 88, 90 ? Amprenavir 10, 32, 46, 47, 50V, 54, 84 ? Lopinavir/r 10, 20, 24, 46, 53, 63, 71, 82, 84, 90 ? Atazanavir 48, 50L, 71, 84, 88, 90 Key mutations: Nucleoside RTI ? M184V: high level resistance to 3TC ? K65R: – Resistance to all nucleoside RTIs except AZT. – Selected by tenofovir and other NRTIs (except AZT) ? Thymidine analogue mutations (TAMs): – 41, 67, 70, 210, 215, 219 – Affect susceptibility to d4T and AZT, abacavir (with multiple TAMs) Key mutations: Nonnucleoside RTI ? K103N: high level resistance to efavirenz and nevirapine ? K188L: multi NNRTI resistance ? Usually resistance to one NNRTI leads to crossresistance to other NNRTIs Key mutations: Protease inhibitors ? Generally multiple protease mutations needed to cause resistance – Key mutations: 90, 48, 50, 82, 84 – 5 or more mutations needed to confer resistance to lopinavir/ritonavir ? D30N is selected by nelfinavir, other PIs usually active ? I50V selected by amprenavir, I50L selected by atazanavir during early virologic failure. Other PIs usually still active. 致謝： 本文參考了邵一鳴博士，李敬云教授，徐建青博士的幻燈。 ?藥物即使有耐藥性也可能有益處，因?yàn)橛心退幮酝蛔兊牟《颈让舾卸局甑膹?fù)制適應(yīng)性要差得多。 （ 5）對(duì)于未經(jīng)抗病毒治療的慢性 HIV感染者不一定要做耐藥性檢測(cè)，但當(dāng)有跡象顯示感染的是耐藥性 HIV毒株時(shí)（例如感染來自于正在服用抗病毒藥物的病人），就應(yīng)當(dāng)進(jìn)行耐藥性檢測(cè)。 （ 3）抗病毒治療失敗需要進(jìn)行耐藥性檢測(cè)時(shí)，應(yīng)該在病人仍在服藥時(shí)或停藥后立即（ 4周內(nèi)）進(jìn)行檢測(cè)。 HIV基因型耐藥性檢測(cè)
環(huán)評(píng)公示相關(guān)推薦
鄂ICP備17016276號(hào)-1