河南省新确证HIV感染者中HIV原发耐药状况研究  

The prevalence of primary HIV-1 drug resistance in newly reported HIV infections in Henan

作　　者：刘佳[1] 许巍[2] 何翠[2] 燕晶[2] 邢辉[2] 薛秀娟[1] 孙定勇[1] 朱谦[1] 王哲[1] 

机构地区：[1]河南省疾病预防控制中心性病艾滋病防治研究所,郑州450016 [2]中国疾病预防控制中心性病艾滋病预防控制中心,北京102206

出　　处：《中华流行病学杂志》2016年第5期643-647,共5页Chinese Journal of Epidemiology

基　　金：国家科技重大专项（2012ZX10001002,2012ZX10004905001003）;河南省医学科技攻关计划项目（201404045）;河南省重点科技攻关计划项目（142102310076）

摘　　要：目的了解河南省新确证未进行抗病毒治疗的HIV感染者中HIV耐药株的流行状况。方法收集河南省6个地区2013年1—6月和2014年1—6月新确证上报的HIV感染者的网络直报信息资料，并进行血样采集、基因型耐药检测和序列分析。结果624例患者中有45例患者被检测到耐药株，原发耐药率为7．21％，属中度流行。单因素分析发现女性的原发耐药率高于男性（X2=11．463，P=0．001），20岁以下病例的原发耐药率高于其他年龄段（X2=2．8．969，P=0．011），文盲的原发耐药率高于其他文化水平的人群（x2=18．072，P=0．001），B亚型的原发耐药率高于其他亚型（X2=9．897，P=0．019），多因素分析发现女性中发生原发耐药的风险高（OR=2．194，95％CI：1．111-4．331）。非核苷类反转录酶抑制剂（NNRTI）、核苷类反转录酶抑制剂（NRT1）和蛋白酶抑制剂（PI）耐药突变的发生率分别为4．97％、3．53％和1．12％。M184V／I（2．08％）和K103N／S（2．88％）分别是出现最多的NRTI和NNRTI耐药突变。有4例出现多个NRTI耐药突变。B亚型是624例中占比最多的基因亚型（51．76％，323／624例），其次为CRF07BC（23．72％，148／624例）和CRF01AE（19．71％，123／624例）。结论HIV耐药株在河南省新确证HIV感染者中出现了中度流行，应加强对HIV耐药株传播的监测，适时开展治疗前的耐药检测。Objective To study the prevalence of primary HIV-1 drug resistance in newly reported HIV infected individuals receiving no antiviral treatment in Henan. Methods Network direct reporting information of newly reported HIV infection cases in six cities of Henan during January to June, 2013 and January to June, 2014 were collected, and blood samples were collected from the cases to conduct genotypic drug resistance test and sequence analysis. Results Primary HIV-1 drug resistance was detected in 45 of 624 newly reported HIV infection cases, the prevalence of primary HIV-1 drug resistance was 7.21%, which was classified as moderate. Univariate analysis revealed that the prevalence of primary HIV-1 drug resistance was higher in females （X2= 11.463, P= 0.001）, in age group 〈20 years （X2=8.969, P=0.011）, in illiterates （X2= 18.072, P=0.001） and in cases of HIV subtype B infection （X2=9.897, P=0.019）. Multi-univariate analysis revealed that the risk of primary HIV-1 drug resistance was high in females （0R=2.194, 95%CI： 1.111-4.331）. Nonnucleoside reverse transcriptase inhibitor （NNRTI）, Nucleoside reverse transcriptase inhibitor （NRTI） and Protease inhibitor （PI） resistance mutations were found in 4.97%, 3.53% and 1.12% of the cases,respectively. M184V/I （2.08%） and K103N/S （2.88%） were the most commonly emerged NRTI and NNRTI resistance mutation. Multiple NRTI resistance mutation was found in four cases. HIV subtype B infections accounted for largest proportion （51.76%, 323/624）, followed by CRF07_BC cases （23.72%, 148/624） and CRF01_AE cases （19.71%, 123/624）. Conclusion The prevalence of primary HIV-1 drug resistance was moderate in the newly reported HIV infected individuals in Henan. The surveillance for HIV-1 drug resistance transmission should be strengthened and drug resistance test before the antiviral treatment should be given.

关 键 词：艾滋病病毒感染 新确证 原发耐药 

分 类 号：R512.91[医药卫生—内科学]