Objective: To analyze the incidence and related factors of drug resistance in HIV-infected pregnant and postpartum women in some areas of three western provinces of China from 2017 to 2019. Methods: From April 2017 to April 2019, face-to-face questionnaires and blood sample testing were conducted in all health care institutions providing maternal and perinatal care and midwifery-assisted services in 7 prevention of mother-to-child transmissi project areas in Xinjiang, Yunnan and Guangxi provinces/autonomous regions. Information was collected during the perinatal period and viral load, CD4+T lymphocytes and drug resistance genes were detected at the same time. The multivariate logistic regression model was used to analyze the relationship between different factors and drug resistance in HIV-infected pregnant and postpartum women. Results: A total of 655 HIV-infected pregnant and postpartum women were included in this study. The incidence of drug resistance was 3.4% (22/655), all of whom were cross-drug resistant. The rate of low, moderate and high drug resistance was 2.1% (14/655), 1.2% (8/655) and 0.8% (5/655), respectively. The drug resistance rate in the people who had previously used antiviral drugs was 1.9% (8/418), and the drug resistance rate in the people who had not used drugs was 5.9% (14/237). The NNRTI drug resistance accounted for 2.8% (18/655) and the NRTI drug resistance rate was 2.5% (16/655). The multivariate logistic regression model showed that the risk of HIV resistance was lower in pregnant women who had previously used antiviral drugs (OR=0.32, 95%CI: 0.11-0.76). Conclusion: Strengthening the management of antiviral drug use and focusing on pregnant and postpartum women who have not previously used antiviral drugs can help reduce the occurrence of drug-resistant mutations. Personalized antiviral therapy should be considered to achieve viral inhibition effects in clinical practice.
目的： 分析2017—2019年我国西部三省部分地区HIV感染孕产妇耐药发生率和相关因素。 方法： 于2017 年 4 月至2019 年 4 月在新疆、云南、广西三个省/自治区的7个预防艾滋病母婴传播项目地区所有提供孕产期保健及助产服务的医疗保健机构开展面对面问卷调查和血样本检测，完成孕期、分娩前和产后相关情况的信息收集和不同时期病毒载量、CD4+T 淋巴细胞、耐药基因的检测。采用多因素logistic回归模型分析不同因素与HIV感染孕产妇发生耐药的关系。 结果： 本研究共纳入655例HIV感染孕产妇，耐药发生率为3.4%（22/655），均为交叉耐药，低度耐药率为2.1%（14/655），中度耐药率1.2%（8/655），高度耐药率为0.8%（5/655），既往应用过抗病毒药物的人群中耐药率为1.9%（8/418），未应用过药物的人群为5.9%（14/237），NNRTI类耐药占2.8%（18/655），NRTI类耐药2.5%（16/655）。多因素logistic回归模型显示，既往应用过抗病毒药物的孕产妇发生HIV耐药的风险更低（OR=0.32，95%CI：0.11~0.76）。 结论： 加强抗病毒药物使用的管理，重点关注既往未应用抗病毒药物的孕产妇，有助于降低耐药突变的发生，临床上应考虑个性化的抗病毒治疗方案实现病毒抑制的效果。.