2012-2014年上海市男男性行为者HIV-1新诊断感染者原发耐药演变趋势  

Prevalence of primary drug-resistance among newly diagnosed HIV-1 infected men who have sex with men in Shanghai,2012-2014

作　　者：王绪琴[1] 郁晓磊 林怡[1] 盖晶[1] 郑敏[2] 周艳秋[3] 吴健[4] 张鹏[5] 陶静[6] 薛以乐[1] 康来仪[1] 

机构地区：[1]上海市疾病预防控制中心,上海200336 [2]上海市长宁区疾病预防控制中心,上海200051 [3]上海市静安区疾病预防控制中心,上海200041 [4]上海市黄浦区疾病预防控制中心,上海200023 [5]上海市浦东新区疾病预防控制中心,上海200136 [6]上海市虹口区疾病预防控制中心,上海200082

出　　处：《中国艾滋病性病》2017年第12期1119-1123,共5页Chinese Journal of Aids & STD

基　　金：上海市卫生和计划生育委员会青年项目(20134Y070);上海市自然科学基金项目(16ZR1429900)~~

摘　　要：目的了解2012-2014年上海市男男性行为者(MSM)1型艾滋病病毒(HIV-1)新诊断感染者中原发耐药水平和流行现状,为调整抗病毒治疗策略提供依据。方法对2012-2014年HIV-1抗体确证首次阳性,未接受过抗病毒治疗的MSM感染者,随机抽取其冻存血浆703例。采用反转录聚合酶链式反应(RT-PCR)扩增和脱氧核糖核酸(DNA)测序,对样本进行病毒亚型、主要耐药相关突变和原发耐药率分析,同时收集调查问卷表。结果获得601例HIV-1pol区基因片段,扩增成功率85.5%,其亚型分布为CRF01_AE 363例(60.4%),CRF07_BC 158例(26.3%),B亚型48例(8.0%),其他亚型和重组体32例(5.3%);601例中有32例感染者带有一个或以上耐药相关突变,原发耐药率5.3%,分别为蛋白酶抑制剂相关耐药发生率2.0%,核苷类反转录酶抑制剂相关耐药发生率1.5%,非核苷类反转录酶抑制剂相关耐药发生率2.8%;2012-2014年间原发耐药率由2.9%上升至8.0%;有20例感染者带有一个或以上传播耐药相关突变,传播耐药率3.3%,传播耐药突变形式以蛋白酶M46I/L位点最高(8例)。结论上海市MSM新诊断HIV-1感染者原发耐药率呈逐年上升趋势,但传播耐药仍处低度流行水平,应继续加强高危人群监测力度,并开展抗病毒治疗前的耐药性检测。Objective To investigate the prevalence of primary drug-resistance among newly diagnosed HIV-1 infected men who have sex with men（MSM）in Shanghai from 2012 to 2014 and provide basis for the optimization of anti-retroviral therapy（HAART）.Methods The plasma specimens were collected from 703 newly diagnosed and HAART naive HIV-1 infected MSM from 2012 to 2014.Genetic subtypes,drug-resistance mutations and rate were analyzed by RT-PCR,nested PCR,DNA sequencing,HIV blast and phylogenetically analysis.Results A total of601 pol gene fragments were obtained,and CRF01AE accounted for 60.4%,followed by CRF07BC（26.3%）,B（8.0%）,and other unique recombinant forms（5.3%）,with the constituent ratio of CRF01AE decreasing and CRF07BC increasing.32 samples contained one or more drug-resistance mutations,and the prevalence of primary drug-resistance was 5.3%.Mutations associated with resistance to protease inhibitor（PI）,nucleoside reverse transcriptase inhibitors（NRTI）and nonnucleoside reverse transcriptase inhibitors（NNRTI）were 2.0%,1.5%and 2.8%,respectively.The prevalence of primary drug-resistance was increased from 2.9%in 2012 to 8.0%in 2014.And 20 samples contained one or more transmitted drug-resistance（TDR）mutations,and the prevalence of TDR was 3.3%.M46 I/L,a PI-associated mutations,was the most frequently occurred TDR（8 cases）.Conclusion The prevalence of primary drug-resistance among MSM in Shanghai was on the increase.However,the TDR rate was at a low level.It is necessary to strengthen the surveillance of the high risk-group of HIV transmission and HIV drug-resistance should be assayed before HAART.

关 键 词：男男性行为者 艾滋病病毒 亚型 原发耐药 传播耐药 

分 类 号：R373.9[医药卫生—病原生物学]