安徽省485例抗病毒治疗失败艾滋病患者耐药基因型分析  

Drug resistance genotype analysis of 485 AIDS patients who failed in antiviral treatment in Anhui Province

作　　者：缪礼锋[1] 沈月兰[1] 苏斌[1] 程晓莉[1] 吴建军[1] MIAO Li-feng;SHEN Yue-lan;SU Bin;CHENG Xiao-li;WU Jian-jun(Anhui Provincial Center for Disease Control and Prevention, Hefei , Anhui 230601,China)

机构地区：[1]安徽省疾病预防控制中心

出　　处：《中国卫生检验杂志》2019年第19期2339-2343,2346,共6页Chinese Journal of Health Laboratory Technology

摘　　要：目的研究接受高效抗反转录病毒治疗失败的艾滋病患者体内病毒的耐药突变位点,为及时调整药物治疗方案提供依据。方法以安徽省2014年收集的487例病毒载量>1000copies/ml的在治患者标本为研究对象,应用巢式反转录PCR( reverse transcription-polymerase chain reaction, RT- PCR)扩增HIV-1聚合酶( pol)基因区,经DNA测序后与国际耐药数据库比对,确定HIV-1基因亚型,分析耐药突变位点。结果成功获得 pol区序列485条,以B亚型为主,有313例(64.5%),其次是CRFO1_ AE亚型116例(23.9%);突变率排在前三位的蛋白酶抑制剂( PIs)耐药基因突变分别是A71T(30. 4%)、A71V(24. 1%)、L10I(10.7%);突变率排在前三位的核苷类反转录酶抑制剂( NRTIs)耐药相关基因分别是M184V(31.1%)、T215Y(5.2%)和M41L(4.4%);突变率排在前三位的非核苷类反转录酶抑制剂(NNRTIs)耐药相关基因分别是K103N(14.8%)、Y181C(8. 9%)和G190A(6.1%)。结论安徽省治疗人群仍以 B亚型为主;发生了针对PIs、NRTIs和NNRTIs的不同耐药突变株,了解耐药位点特征对预防和控制耐药株发生有重要意义。Objective To study the distribution of drug resistance mutation sites in HIV patients who failed to receive highly active antiretroviral therapy ( HAART), so as to provide basis for timely adjustment of drug treatment program. Methods A total of487 HIV-1 polymerase (pol) gene regions were amplified by nested reverse transcription-polymerase chain reaction (RT- PCR) in 487 HIV-positive patients with viral load greater than 1 000 copies/ml collected in Anhui Province in 2014. Compared with an international HIV resistance database after DNA sequencing, to identify the subtype of HTV-1 gene, and find drug resistance mutation sites. Results Totally 485 pol sequences were successfully obtained. The main genotype was B subtype (n=313, 64. 5%) cases, followed by 116 cases (23. 9%) of CRF01_AE subtype. Protease inhibitors (PIs) resist-ance gene mutations were A71T (30.4%), A71V (24. 1%) and L10I (10.7%) in the top three mutation rates,and nucleo- side reverse transcriptase inhibitors ( NRTTs) resistance gene mutations were M184V (31. 1%),T215Y (5. 2%) and M41L (4.4%) in the top three mutation rates, and the resistance-related gene mutations of NNRTIs were K103N ( 14. 8%), Y181C (8. 9%) and C190A (6. 1%) in the top three mutation rates. Conclusion The subtype B is still the main subtype of the treatment population in Anhui Province;different drug-resistant mutants of PIs, NRTIs and NNRTIs have occurred in the treatment population, and understanding the diversity of gene mutations and the characteristics of drug resistance sites of HIV -1 resistant strains is of great significance to the prevention and control of the spread of drug-resistant strains.

关 键 词：艾滋病 抗病毒治疗 亚型 耐药 

分 类 号：R512.91[医药卫生—内科学]