哈尔滨市39例HIV-1毒株原发耐药的变异研究  

Drug resistant mutations in HIV-1 strains of treatment-naive patients in Harbin,China

作　　者：李文静[1] 李航[2] 王福祥[1] 李用国[1] 

机构地区：[1]哈尔滨医科大学附属第一医院感染科,黑龙江哈尔滨150001 [2]哈尔滨医科大学流行病学教研室,黑龙江哈尔滨150081

出　　处：《中国病毒病杂志》2012年第6期440-445,共6页Chinese Journal of Viral Diseases

基　　金：国家"十一五"艾滋病和病毒性肝炎等重大传染病防治科技重大专项(2008ZX10001-006)

摘　　要：目的分析哈尔滨市39例未经抗病毒治疗的HIV-1感染者原发耐药的情况,明确哈尔滨市HIV/AIDS患者原发耐药的耐药谱,为今后该市确定对于HIV/AIDS患者进行高效抗逆转录病毒治疗方案提供参考。方法应用逆转录聚合酶链式反应(RT-PCR)方法对哈尔滨市39例未经抗病毒治疗的HIV-1感染者血浆HIVpol基因序列进行扩增,分析耐药突变位点以及对各类抗病毒药物的耐药程度。结果 39例扩增阳性的pol区基因中,系统进化树分析结果显示:B亚型共18例(46.15%),包括泰国B′7例(17.95%),欧美B 11例(28.21%);CRF01_AE亚型15例(38.46%);07_BC亚型5例(12.82%);1例出现CRF01_AE与A亚型的重组(2.56%)。基因型耐药结果分析显示:针对蛋白酶抑制剂,未出现蛋白酶抑制剂(PI)主要耐药突变,9例出现次要耐药突变(L10I、A71T/V)。针对核苷类逆转录酶抑制剂(NRTI)和非核苷类逆转录酶抑制剂(NNRTI),出现3例核苷类逆转录酶抑制剂耐药突变(K219Q、T69N),导致对去羟肌苷(ddI)、齐多夫定(AZT)、司他夫定(d4T)的潜在低度耐药;出现10例非核苷类逆转录酶抑制剂耐药突变(V179D/E),导致对依非韦伦(EFV)、奈韦拉平(NVP)潜在低度耐药。结论哈尔滨市未经治疗的HIV-1感染者中原发耐药的发生率出现上涨趋势,需引起足够的重视。Objective To study the condition of drug resistance in treatment-naive HIV/AIDS cases in Harbin city of China.Methods The partial gene fragment of HIV-1 pol gene was amplified by RT-PCR and sequenced from a total of 39 plasma samples of HIV-1 positive patients.The obtained sequences were submitted to Standford HIV Drug Resistance Database to identify mutations related to HIV-1 drug resistance and the resistant levels to different drugs.Results Phylogenetic analysis of the pol gene sequences revealed that 18（46.15%）out of 39 samples were classified as subtype B（7 Thailand B,11 US B）;15,5,1 and 1 as subtype CRF01_AE,07_BC,01_AE and subtype A,respectively.No protease-associated mutations were detected,while 9 protease inhibitor-associated secondary mutations were found（L10I,A71T/V）.In addition,three NRTI-resistant（K219Q,T69N）and 10 NNRTI-resistant strains（V179D/E）were detected.Conclusions Secondary mutations in the protease and reverse transcriptase gene are common in treatment-naive patients in Harbin city,China.More attention should be paid to the surveillance of these drug resistance mutations for the effective prevention and treatment of HIV-1 infection.

关 键 词：HIV-1 反转录酶 蛋白酶 耐药相关变异 

分 类 号：R512.91[医药卫生—内科学]