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DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 張淑媛(Sui-Yuan Chang) | |
dc.contributor.author | Chung-Chih Lai | en |
dc.contributor.author | 賴宗志 | zh_TW |
dc.date.accessioned | 2021-06-16T23:16:15Z | - |
dc.date.available | 2013-09-19 | |
dc.date.copyright | 2012-09-19 | |
dc.date.issued | 2012 | |
dc.date.submitted | 2012-08-01 | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/65028 | - |
dc.description.abstract | 1. Transmitted Drug Resistance of HIV-1 in Taiwan
Background: Drug-resistant strains of HIV-1 emerged soon after antiretroviral therapy (ART) was introduced. Transmission of the resistance mutations has been observed in 6-16% of antiretroviral-naive patients in Europe and North America and has been shown to compromise the treatment effectiveness of first-line ART. The impact of transmitted drug resistance (TDR) of HIV-1 on treatment outcome is largely unknown in areas where routine testing for drug resistance may not be available before highly active antiretroviral therapy (HAART) is initiated. Methods: Genotypic resistance assays were performed on HIV isolates from archived blood samples obtained from 1,349 antiretroviral-naive HIV-1-infected patients in Taiwan from 2000 to 2010. Resistance mutations were interpreted with the use of the HIVdb program of the Stanford University HIV Drug Resistance Database. The genotypic sensitivity score (GSS) of the regimens prescribed was calculated. A matched case–control study was conducted to assess the impact of TDR on treatment outcomes. Results: The overall prevalence of TDR to any antiretroviral agent was 8.0%, declining from 12.3% in 2003–06 to 5.1% in 2007–10. In the matched case–control study, 31 patients with high- or intermediate-level resistance, 16 with low-level resistance and 89 controls were enrolled. Compared with regimens with GSS > 2.5, initiation of regimens with GSS ≤ 2.5 was associated with a higher treatment failure rate (39.3% versus 15.7%, P = 0.02) and shorter time to treatment failure (log-rank P <0.001). In patients receiving regimens with GSS ≤ 2.5, protease inhibitor-based regimens were less likely to result in treatment failure, compared with non-nucleoside reverse-transcriptase inhibitor-based regimens (hazard ratio 0.26, 95% confidence interval 0.06–1.12, P = 0.07). Conclusions: In Taiwan, the prevalence of TDR of HIV-1 strains declined and stabilized between 2007 and 2010. Receipt of antiretroviral regimens with GSS ≤ 2.5 was associated with poorer treatment responses than regimens with GSS > 2.5. 2. Immunologic Progression of Patients Infected with HIV-1 CRF07_BC in Taiwan Background: HIV-1 circulating recombinant form (CRF) 07_BC causes serious HIV-1 epidemics in East Asia. Almost all injecting drug users (IDUs) infected in the outbreak in Taiwan between 2003 and 2007 were CRF07_BC-infected. Little is known about its influence on disease progression. Methods: IDUs diagnosed as having HIV infection between 2004 and 2007 were enrolled. The comparator group included patients with primary HIV-1 infection via sexual contacts. All participants were treatment-naive and received free-of-charge HIV care. Immunologic progression was defined as the onset of CD4 cell counts <350 cells/mm3. Results: During the study period, 384 IDUs and 191 patients of the non-IDU group were included. In the non-IDU group, 185 (96.9%) were men who have sex with men (MSM) and 94.0% of them were infected with subtype B. The IDUs were demographically different from the non-IDU group. Kaplan-Meier plots showed significantly slower immunologic progression in the IDU group (P<0.001 by log rank test). In Cox proportional hazards models, IDUs infected with CRF07_BC were associated with slower immunologic progression (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.21-0.93; P=0.03), after adjustment for age, gender, baseline CD4 cell counts and plasma HIV RNA load , and symptoms of seroconversion. Conclusions: IDUs infected with HIV-1 CRF07_BC had slower immunologic progression, compared with MSM infected with subtype B. | en |
dc.description.provenance | Made available in DSpace on 2021-06-16T23:16:15Z (GMT). No. of bitstreams: 1 ntu-101-P99421017-1.pdf: 7147491 bytes, checksum: 7131a3592b45138e4d27780faf41d4b1 (MD5) Previous issue date: 2012 | en |
dc.description.tableofcontents | 1. Transmitted Drug Resistance of HIV-1 in Taiwan
口試委員會審定書 I 謝辭 II 中文摘要 IV 英文摘要 VI 目錄 VIII 表目錄 X 圖目錄 XI 第一章 緒論…………………………………………………………………………... 1 1.1 人類免疫缺乏病毒的治療…………………………………………………. 1 1.2 人類免疫缺乏病毒的抗藥性………………………………………………. 2 1.2.1產生機轉及分類……………………………………………………. 2 1.2.2 TDR在各國之盛行率……………………………………………… 3 1.2.3 TDR的檢測方法及判讀標準……………………………………… 4 1.2.4 TDR對於第一線抗病毒藥物治療的影響………………………… 6 1.3 台灣地區HIV流行之現況………………………………………………… 8 1.4 研究目的……………………………………………………………………. 9 第二章 研究方法與材料…………………………………………………………… 10 2.1 研究族群與檢體收集………………………………………………………. 10 2.2 基因型抗藥性檢測及判讀…………………………………………………. 10 2.3 病例對照研究………………………………………………………………. 11 2.4 抗病毒藥物之使用…………………………………………………………. 12 2.5 治療結果……………………………………………………………………. 12 2.6 統計分析……………………………………………………………………. 13 第三章 結果………………………………………………………………………… 14 3.1 TDR在台灣的盛行率…………………………………………………….. 14 3.2 病例對照研究………………………………………………………………. 14 3.3 對第一線抗病毒藥物的治療反應…………………………………………. 15 3.4 各項因子對治療結果之影響………………………………………………. 16 第四章 討論………………………………………………………………………… 18 4.1 台灣TDR盛行率的趨勢…………………………………………………… 18 4.2 TDR對於治療結果之影響……………………………………………….. 19 4.3 處方對治療結果之影響……………………………………………………. 20 4.4 研究限制……………………………………………………………………. 21 第五章 結論與展望………………………………………………………………… 23 第六章 參考文獻…………………………………………………………………… 24 第七章 表…………………………………………………………………………… 38 第八章 圖…………………………………………………………………………… 50 第九章 附錄………………………………………………………………………… 63 2. Immunologic Progression of Patients Infected with HIV-1 CRF07_BC in Taiwan 中文摘要 II 英文摘要 III 目錄 V 表目錄 VII 圖目錄 VIII 第一章 緒論………………………………………………………………………….. 1 1.1 人類免疫缺乏病毒之分型…………………………………………………. 1 1.2 病毒分型的影響……………………………………………………………. 2 1.3 重組亞型CRF07_BC………………………………………………………. 3 1.3.1流行概況……………………………………………………………. 3 1.3.2病毒特性…………………………………………………………….. 4 1.4 台灣HIV之流行現況及分子流行病學…………………………………… 5 1.5 研究目的......................................................................................................... 6 第二章 研究方法與材料............................................................................................... 7 2.1 研究族群與檢體收集………………………………………………………… 7 2.2 病毒分型之檢測……………………………………………………………… 8 2.3 免疫學上的進展 (immunologic progression)……………………………….. 9 2.4 統計分析.......................................................................................................... 10 第三章 結果................................................................................................................. 11 3.1 病人的基本資料…………………………………………………………….. 11 3.2 預後………………………………………………………………………….. 11 3.3 CD4淋巴球數下降之速率………………………………………………….. 13 第四章 討論................................................................................................................. 14 4.1 HIV疾病進程之影響因子…………………………………………………... 14 4.2 研究限制…………………….......................................................................... 16 第五章 結論與展望…………………………………………………………………. 19 第六章 參考文獻……………………………………………………………………. 21 第七章 表……………………………………………………………………………. 33 第八章 圖……………………………………………………………………………. 36 | |
dc.language.iso | zh-TW | |
dc.title | 1.臺灣原發性抗藥之人類免疫缺乏病毒
2.人類免疫缺乏病毒之亞型CRF07_BC之病程 | zh_TW |
dc.title | 1. Transmitted Drug Resistance of HIV-1 in Taiwan
2. Immunologic Progression of Patients Infected with HIV-1 CRF07_BC in Taiwan | en |
dc.type | Thesis | |
dc.date.schoolyear | 100-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 洪健清(Chien-Ching Hung),楊宏志 | |
dc.subject.keyword | 抗藥性突變,雞尾酒療法,靜脈藥癮者,病毒分型, | zh_TW |
dc.subject.keyword | genotypic resistance mutations,highly active antiretroviral therapy,HIV infection,injecting drug users,immunologic progression,non-B subtype,clades, | en |
dc.relation.page | 132 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2012-08-01 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床醫學研究所 | zh_TW |
顯示於系所單位: | 臨床醫學研究所 |
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