上海市卢湾区人免疫缺陷病毒-1型分子流行病学和耐药监测  

Molecular epidemiology and drug resistance:Survey on human immunodeficiency virus type 1 in Luwan District of Shanghai

作　　者：吴健[1] 薛以乐[2] 康来仪[2] 

机构地区：[1]上海市卢湾区疾病预防控制中心性病结核病防治科,上海200025 [2]上海市疾病预防控制中心艾滋病性病防治科,上海200336

出　　处：《诊断学理论与实践》2012年第3期278-282,共5页Journal of Diagnostics Concepts & Practice

基　　金：国家"十二五"艾滋病和病毒性肝炎等重大传染病防治重大科技专项(2012ZX10001-002-002-012)

摘　　要：目的:了解上海市卢湾区2010年确认的未经抗病毒治疗HIV-1感染者亚型分布和原发性耐药的流行情况,为当前该区制定艾滋病防治策略提供科学依据。方法:随机选取确认HIV-l感染者血浆标本77份,运用反转录-聚合酶链反应(RT-PCR)扩增,进行DNA测序及系统进化树分析,同时与国际HIV耐药数据库比对,并结合流行病学资料进行分析。结果:获得45份pol区基因片段,其中亚型分布显示,CRF01_AE亚型占68.9%(31/45),CRF07_BC亚型占22.2%(10/45)、B亚型占6.7%(3/45)和C亚型为2.2%(1/45)。CRF01_AE亚型以性传播途径为主,其中男男同性接触(MSM)和异性性传播分别占为66.7%(20/30)和33.3%(10/30),在异性性传播、MSM和注射毒品中均存在CRF07_BC;B亚型均为MSM人群,C亚型为异性性接触者。本研究共发现3例耐药者,包括同时发生对核苷类反转录酶抑制剂(NRTIs)和非核苷类反转录酶抑制剂(NNRTIs)的原发耐药、只对NNRTIs的原发耐药和对整合酶抑制剂(INIs)的原发耐药各1例。测得的耐药突变位点为L74IL、V179D及V179E、E92Q和L74M。结论:上海市卢湾区2010年新确认HIV-1感染者中以CRF01_AE和CRF07_BC为主,在耐药监测中发现NRTIs、NNRTIs和INIs耐药突变株;加强对HIV-1分子流行病学和耐药的监测具有公共卫生意义。Objective To study the HIV-1 subtype distribution and prevalence of primary drug resistance in antiretroviral treatment-naive HIV-1 infected individuals diagnosed in 2010 and living in Luwan District of Shanghai for providing a basis to help the formation of AIDS prevention and control strategy.Methods Seventy-seven plasma samples of HIV-1 infection were selected randomly,and pol gene fragments were amplified by nested RT-PCR,followed by DNA sequencing and phylogenetic subtyping.Drug resistances were analyzed by contrasting with the International HIV Drug Resistance Database.Results Forty-five pol gene fragments were obtained.Subtyping result showed that subtype CRF01_AE occurred in 68.9%（31/45）,followed by subtype CRF07_BC in 22.2%（10/45）,subtype B in 6.7%（3/45） and subtype C in 2.2%（1/45）.In addition,subtype CRF01_AE was mainly from sexual transmission,in which the male homosexual transmission and heterosexual transmission accounted for 66.7%（20/30） and 33.3%（10/30）,respectively.Subtype CRF07_BC existed in heterosexual,homosexual transmission and drug injection.Subtype B was from homosexual and subtype C was from heterosexual contact.Drug resistance to NRTIs,NNRTIs and INIs was identified in three cases.The sites of drug resistance mutation were L74IL,V179D/E,E92Q and L74M.Conclusions The survey finds that subtypes CRF01_AE and CRF07_BC are dominating in Luwan District.The prevalence of drug resistance strains is still low.Strengthening the molecular epidemiological survey and monitoring drug resistance are meaningful for public health.

关 键 词：人免疫缺陷病毒-1型 基因亚型 重组体 原发耐药 

分 类 号：R512.91[医药卫生—内科学]