2014—2017年上海市长宁区男男性行为人群HIV-1型感染者原发性耐药分析  

Primary drug resistance of newly diagnosed HIV-1 infected men who have sex with men in Changning District of Shanghai,2014-2017

作　　者：郑敏[1] 许安阳 尹宁[1] 倪莹青[1] 朱晓华[1] 王苇沁 王震宇[1] 薛以乐[2] 宁镇[2] ZHENG Min;XU An-yang;YIN Ning;NI Ying-qing;ZHU Xiao-hua;WANG Wei-xin;WANG Zhen-yu;XUE Yi-le;NING Zhen(Changning District Center for Disease Control and Prevention,Shanghai 200051,China;Shanghai Municipal Center for Disease Control and Prevention,Shanghai 200336,China)

机构地区：[1]上海市长宁区疾病预防控制中心,上海200051 [2]上海市疾病预防控制中心,上海200336

出　　处：《上海预防医学》2019年第12期973-977,982,共6页Shanghai Journal of Preventive Medicine

摘　　要：【目的】了解上海市长宁区2014-2017年男男性行为(MSM)人群HIV-1型感染者亚型分型及原发性耐药情况,为制定该人群抗病毒治疗方案提供依据。【方法】选取2014-2017年首次确证HIV-1型阳性、未接受过抗病毒治疗的MSM感染者363例,对其血浆标本采用反转录聚合酶链反应(RT-PCR)扩增、DNA测序,并对序列进行亚型及原发性耐药分析。【结果】363例感染者的标本经RT-PCR筛选,最终获得300例的HIV-1 pol基因片段,扩增率为82. 6%。年龄18~78岁;非上海市户籍212例,占70. 7%;大专及以上文化程度165例,占55. 0%;未婚为主占71. 7%;CRF01_AE亚型154例(51. 3%),CRF07_BC亚型104例(34. 7%),其他亚型和重组体42例(14. 0%);18例有耐药突变,原发耐药率为6. 0%(18/300),其中对非核苷类反转录酶抑制剂的耐药率为4. 3%(13/300),对核苷类反转录酶抑制剂的耐药率为2. 7%(8/300),突变位点PI区的耐药率为1. 3%(4/300),2种及以上合并耐药率为2. 0%(6/300)。【结论】上海市长宁区MSM人群HIV-1型感染者以CRF01_AE亚型为主,且对非核苷类反转录酶抑制剂类药物的原发性耐药率较高,临床治疗中使用非核苷类的药物需谨慎;另外,仍要加强对MSM感染者耐药的监测工作。[Objective] To investigate the characteristics,subtype and primary drug resistance among HIV-1 infected men who have sex with men(MSM) in Changning District of Shanghai from 2014 to 2017,and to provide evidence for antiretroviral therapy(ART). [Methods] A total of 363 newly diagnosed HIV-1 positive MSM were chosen from 2014 to 2017 with ART free to analysis HIV-1 subtype and primary drug resistance via reverse transcription-polymerase chain reaction(RT-PCR) and sequencing. [Results] The 300 pol gene fragments were finally obtained from RT-PCR. These cases were aged from 18 to 78 years;212 of them(71. 7%) came from other provinces;165(55. 0%) had education level of college or above;71. 7% were unmarried;154(51. 3%) were with the subtype of CRF01_AE;104(34. 7%) with the subtype of CRF07_BC and 42(14. 0%) with the subtype of other recombinants. Eighteen cases(6. 0%) had the primary drug resistance mutations. The mutation associated drug resistant rates to non-nucleoside reverse transcriptase inhibitors(NNRTI), nucleoside reverse transcriptase inhibitors(NRTI) and protease inhibitors(PI) were 4. 3%(13/300),2. 7%(8/300) and 1. 3%(4/300),respectively;2. 0%(6/300) of the cases owned two or more resistance mutations at the same time. [Conclusion] CRF01_AE is the major subtype among HIV-1 infected MSM in Changning District,Shanghai,and the primary drug resistance mutation associated with NNRTI is relatively high,indicating that more attention should be paid to the use of NNRTI in clinic and more powerful surveillance for MSM primary drug resistance needed.

关 键 词：男男性行为人群 HIV-1型 亚型/重组体 原发性耐药 

分 类 号：R512.91[医药卫生—内科学]