北京地区未经抗病毒治疗的HIV感染者HIV-1毒株耐药基因变异研究  

Genotypic resistance mutations to antiretroviral drugs in nave HIV-1 carriers in Beijing

作　　者：宋映雪[1] 辛若雷[2] 叶军[1] 李在村[1] 贺亮[1] 刘安[1] 叶江竹[1] 李建维[1] 伦文辉[3] 卢红艳[2] 孙丽君[1] 

机构地区：[1]首都医科大学附属北京佑安医院,北京100069 [2]北京市疾病预防控制中心,北京100013 [3]首都医科大学附属北京地坛医院,北京100015

出　　处：《中国艾滋病性病》2015年第10期836-838,共3页Chinese Journal of Aids & STD

基　　金：国家自然科学基金(81273136);北京市医院管理局临床医学发展专项经费资助(ZY201401)~~

摘　　要：目的观察北京地区未经抗病毒治疗的艾滋病病毒（HIV）感染者HIV-1毒株耐药基因的变异情况,用于指导临床用药。方法以2014年4-7月北京地区601例未经抗反转录病毒治疗的HIV感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）为对象。采集病人的静脉血,提取血浆病毒核糖核酸（RNA）,用反转录/巢式聚合酶链式反应扩增病毒pol基因,并进行序列测定和亚型分析。在Stanford University HIV耐药数据库查询,分析是否存在基因型耐药以及耐药种类。结果 601例未经抗反转录病毒治疗的HIV/AIDS病人中,扩增成功的458例,其中男性434例（94.8%）,女性24例（5.2%）;平均年龄33岁（17~77岁）。主要感染亚型依次为CRF01_AE（211例,46.1%）、CRF07_BC（126例,27.5%）、B亚型（106例,23.1%）和C亚型（15例,3.3%）。在扩增成功的病人中,7.4%（34/458）的病人存在原发耐药基因变异,其中7例病人对核苷类反转录酶抑制剂（NRTIs）耐药,16例病人对非核苷类反转录酶抑制剂（NNRTIs）耐药,8例对蛋白酶抑制剂（PIs）耐药,3例病人同时对NRTIs和NNRTIs耐药。结论北京地区未经治疗的HIV/AIDS病人中,有部分病人存在原发耐药基因变异,极少数病人同时存在对两种主要治疗药物耐药,因此治疗前需要根据耐药检测结果制定用药方案,有助于提高治疗有效率,避免治疗失败。Objective To identify the variation of HIV-1strains resistant gene without antiretroviral therapy（ARI）in Beijing area and to give experience on clinical practice.Methods From April to July 2014,601 cases without antiretroviral treatment of HIV infection/AIDS（HIV/AIDS patients）in Beijing were extracted plasma viral RNA,amplified viral pol gene by reverse transcription/nested polymerase chain reaction,and then carried out sequence determination and subtype analysis.It was queried in the Stanford University HIV drug resistance database and analyzed whether there was genotypic resistance and resistant species.Results There were 458 successfully amplified cases,434 were male（94.8%）and 24 were female（5.2%）with average age of 33years（17~77years old）.The sequence of primary infection subtype was CRF01_AE（n=211,46.1%）,CRF07_BC（n=126,27.5%）,B subtype（n=106,23.1%）,and C subtype（n=15,3.3%）.In the 458 cases,7.4%（34/458）patients suffered primary drug resistance gene mutation,7cases of nucleoside reverse transcriptase inhibitors（NRTIs）resistance,16 cases of non-nucleoside reverse transcriptase inhibitors（NNRTIs）resistance,8cases of protease inhibitors（PIs）resistant,3cases of NRTIs and NNRTIs resistance.Conclusion There were primary drug resistance gene mutation partially in the untreated HIV/AIDS patients in Beijing area.A very few patients were even resistance for two main drugs.Hence,it is necessary to develop drug program according to drug resistance test results before treatment.It will contribute to the improvement of treatment efficiency and prevention of treatment failure.

关 键 词：艾滋病 抗病毒治疗 原发耐药 基因突变 

分 类 号：R512.91[医药卫生—内科学]