德宏傣族景颇族自治州276例抗病毒治疗脱失的HIV感染者的毒株基因亚型和耐药分析  

HIV gene subtype and drug resistance among HIV-1 infected patients dropout of antiretroviral therapy in Dehong prefecture

作　　者：王继宝[1] 石瑞紫 王译葵 周素娟[2] 段星[1] 姚仕堂[1] 曹东冬 杨锦[1] 杨世江[1] 杨涛[1] 叶润华[1] 杨跃诚[1] 丁盈盈[2] 何纳[2] 段松[1] WANG Jibao;SHI Ruizi;WANG Yikui;ZHOU Sujuan;DUAN Xing;YAO Shitang;CAO Dongdong;YANG Jin;YANG Shijiang;YANG Tao;YE Runhua;YANG Yuecheng;DING Yingying;HE Na;DUAN Song(Department of STD/AIDS Prevention and Control,Dehong Prefecture Center for Disease Control and Prevention,Dehong 678400,Yunnan,China;Department of Epidemiology,School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education,Fudan University,Shanghai 200032;People’s Hospital of Dehong Prefecture,Dehong 678400,Yunnan)

机构地区：[1]德宏州疾病预防控制中心,云南德宏678400 [2]复旦大学公共卫生学院流行病学教研室,公共卫生安全教育部重点实验室,上海200032 [3]德宏州人民医院,云南德宏678400

出　　处：《中国艾滋病性病》2020年第8期809-813,856,共6页Chinese Journal of Aids & STD

基　　金：国家重点地区艾滋病防治项目;国家科技重大专项(2018ZX10715006-001)。

摘　　要：目的了解云南省德宏傣族景波族自治州(简称德宏州)抗病毒治疗(ART)脱失艾滋病病毒(HIV)感染者中的体内毒株亚型及耐药发生情况。方法2016年,采用方便抽样法随访到276例ART脱失者,采集静脉血检测其血浆HIV病毒载量(VL);对VL≥1000拷贝/mL的患者,通过反转录聚合酶链式反应(RTPCR)扩增HIV的pol区基因,并根据pol区基因序列进行基因亚型和耐药突变分析。结果276例ART脱失者中,VL≥1000拷贝/mL 196例(71.0%),pol区基因成功扩增171例(87.2%);根据pol区基因序列确认有6种基因亚型:BC重组类型毒株76例(44.4%)、C 44例(25.7%)、CRF01_AE 25例(14.6%)、B 11例(6.4%)、CRF08_BC 8例(4.7%)和CRF62_BC 7例(4.1%)。276例ART脱失者中,53例(19.2%)具有耐药突变位点,与HIV亚型分布无关联;37例(13.4%)判定为耐药:1例对核苷类反转录酶抑制剂类药物低度耐药;36例对非核苷类反转录酶抑制剂类药物有不同程度耐药,其中对奈韦拉平、依法韦仑高度耐药在BC重组类型中检出较高。结论德宏州脱失抗病毒治疗的HIV感染者体内病毒基因亚型复杂,且可能存在较高耐药率,其成为耐药毒株传播来源的风险大,应引起高度重视。Objective To investigate the prevalence and genetic mutations of HIV drug resistance among HIV patients who had dropped out of antiretroviral treatment(ART)in Dehong prefecture,Yunnan province.Methods 1052 HIV patients had dropped out of ART by the end of 2015,among whom 276 had been retrieved by using the convenience sampling method in 2016 and tested for plasma HIV viral load(VL).Among those with VL≥1000 copies/ml,amplification of pol gene was performed by using reverse transcription polymerase chain reaction(RT-PCR)and HIV subtypes as well as drug resistant analysis were conducted.Results 196(71.0%)out of the 276 patients had a viral load≥1000 copies/ml,of whom 171(87.2%)were successfully amplified and sequenced,with 6 HIV genotypes including BC(44.4%,76/171),C(25.7%,44/171),CRF01_AE(14.6%,25/171),B(6.4%,11/171),CRF08_BC(4.7%,8/171)and CRF62_BC(4.1%,7/171).53(19.2%,53/276)patients were detected with drug resistant mutations,and they were not associated with the distribution of HIV subtype.37(13.4%,37/276)patients were detected to have HIV drug resistance(HIVDR)under the WHO criteria with one case showing low-level resistance to nucleotide reverse transcriptase inhibitors(NRTIs),and 36 cases showing resistance to non-nucleotide reverse transcriptase inhibitors(NNRTIs)at different levels,among which high-level resistance to Nevirapine(NVP)and Efavirenz(EFV)was prevalent in subtype BC.Conclusion HIV-1 gene subtypes are complex in HIV-infected patients who dropped out of ART in Dehong prefecture and may have high rate of drug resistance.This may increase transmission risk of drug-resistant strains due to their dropout,and effective and targeted measures should be promoted.

关 键 词：艾滋病病毒感染者 抗病毒治疗 脱失 亚型 耐药 

分 类 号：R373.9[医药卫生—病原生物学]