2007-2013年上海市HIV-1感染者毒株耐药监测  

Surveillance for HIV drug resistance in HIV infection cases in Shanghai,2007-2013

作　　者：吴健[1] 陶静[2] 王绪琴[3] 汪红卫[1] 周建军[1] 郑敏[4] 周艳秋[5] 郁晓磊 盖晶[3] 薛以乐[3] 康来仪[3] 

机构地区：[1]上海市黄浦区疾病预防控制中心,上海200023 [2]上海市虹口区疾病预防控制中心,上海200082 [3]上海市疾病预防控制中心,上海200336 [4]上海市长宁区疾病预防控制中心,上海200051 [5]上海市静安区疾病预防控制中心,上海200041

出　　处：《疾病监测》2015年第11期930-934,共5页Disease Surveillance

基　　金：国家"十二五"科技重大专项(No.2012ZX10001-002-002-012)~~

摘　　要：目的了解上海市2007-2013年HIV-1感染者的原发耐药基因突变情况,掌握耐药毒株变化趋势。方法随机选取2007-2013年随访的常住上海未经抗病毒治疗的HIV-1感染者血浆标本1296例,进行反转录-聚合酶链反应(RT-PCR)扩增、DNA测序、亚型鉴定,并与国际HIV耐药数据库比对分析。结果获得1085例pol区基因片段,其中亚型分布显示,CRF01_AE 651例(60.0%),其次为CRF07_BC 253例(23.3%)、B亚型97例(8.9%)、CRF08_BC52例(4.8%)、C亚型12例(1.1%)、CRF01_B 10例(0.9%)、F2亚型2例(0.2%)、G亚型2例(0.2%)、CRF02_AG 5例(0.5%)和CRF03_AB 1例(0.2%)。原发耐药率平均为1.4%,其中核苷类反转录酶抑制剂(NRTI)耐药相关突变率为0.3%(3/1085),非核苷类反转录酶抑制剂(NNRTI)耐药相关突变率为0.9%(9/1085),整合酶抑制剂(IN)耐药相关突变率为0.2%(2/1085)。同时发生对蛋白酶抑制剂(PIs)和NNRTIs的耐药相关突变1例。结论 2007 2013年上海市HIV-1感染者中存在原发耐药基因变异,耐药率呈下降趋势,从2007年的4.5%下降到2013年的1.1%。耐药基因型以CRF01_AE为主,男男同性传播为主,极少数HIV感染者同时存在对2种主要治疗药物耐药,应加强CRF01_AE耐药毒株的动态监测和研究,尤其是在男男性接触人群中的变化趋势。Objective To investigate the drug resistance of human immunodeficiency virus（ HIV）-1 among HIV infection cases in Shanghai and provide evidence for the improvement of anti-retrovirus（ ARV） treatment. Methods A total of 1296 HIV infection cases detected in Shanghai in 2013 were surveyed by detecting their plasma samples. DNA were extracted for reverse transcription-polymerase chain reaction（ RT-PCR） amplification, sequencing. subtype identification. The drug resistance results were compared with those in international HIV drug resistance database.Results A total of 1085 pol gene fragments were obtained from these cases,in which 651 belonged to CRF01_ AE（ 60. 0%）,253 belonged CRF07_BC（ 23. 3%）,97 belonged to subtype B（ 8. 9%）,52 belonged to CRF08_BC（ 4. 8%）,12 belonged subtype C（ 1. 1%）,10 belonged to CRF01_B（ 0. 9%）,2 belonged to subtype F2（ 0. 2%）,2belonged to subtype G（ 0. 2%）,5 belonged to CRF02_ AG（ 0. 5%） and 1 belonged to CRF03_ AB（ 0. 2%）. The prevalence of primary drug-resistance was 1. 4%. The mutation associated drug resistant rates to nucleoside reverse transcriptase inhibitors（ NRTI）,non-nucleoside reverse transcriptase inhibitors（ NNRTI） and integrase inhibitor（ IN）were 0. 3%（ 3 /1085）,0. 9%（ 9 /1085） and 0. 2%（ 2 /1085） respectively. One case of mutation associated drug resistance to protease inhibitors（ PIs） and to NNRTIs were detected respectively. Conclusion The primary drugresistant gene mutation associated drug resistant rate was in decline in HIV infection cases in Shanghai during 2007-2013,which declined from 4. 5% in 2007 to 1. 1% in 2013. HIV with resistant gene CRF01_AE was predominant and mainly circulated in M SM. A very fewHIV infection cases were resistant to 2 antiviral drugs. It is necessary to strengthen the surveillance for HIV with resistant gene CRF01_AE,especially in M SM.

关 键 词：高效抗反转录病毒联合疗法 人类免疫缺陷病毒-1型 亚型/重组体 耐药 

分 类 号：R512.91[医药卫生—内科学]