2019年辽宁地区抗病毒治疗失败病例HIV-1基因型耐药特征分析  

Characteristics of genotypic drug resistance for HIV-1 infections with antiretroviral treatment failrue in 2019,Liaoning

作　　者：赵砚[1] 鄂爽[1] 吕娅妮[1] 康续 王莉[1] ZHAO Yan;E Shuang;LV Ya-ni;KANG Xu;WANG Li(Liaoning Provincial Center for Disease Control and Prevention,Shenyang,Liaoning 110005,China)

机构地区：[1]辽宁省疾病预防控制中心,辽宁沈阳110005

出　　处：《中国国境卫生检疫杂志》2021年第6期384-387,共4页Chinese Journal of Frontier Health and Quarantine

基　　金：国家自然科学基金项目(81273136);辽宁省自然科学基金项目(2020-MS-358)。

摘　　要：目的分析辽宁地区抗病毒治疗失败HIV-1感染者蛋白酶-逆转录酶基因(pol基因片段)及整合酶基因耐药发生特征和水平。方法收集2019年接受艾滋病抗病毒治疗时间>6个月、病毒载量≥1000拷贝/ml的267例HIV-1感染者的血浆样本,扩增pol基因片段,对耐药者进行整合酶基因型耐药检测,将获得的pol基因和整合酶基因序列提交美国斯坦福大学HIV耐药数据库分析耐药位点突变及药物耐受程度。结果267例治疗失败病例pol基因耐药位点突变率为40.8%,最常见的突变位点为G190(17.6%)、K65(16.1%)及M184(12.7%);对蛋白酶抑制剂(PIs)、核苷类反转录酶抑制剂(NRTIs)及非核苷类反转录酶抑制剂(NNRTIs)的耐药率分别为3.0%、25.8%和33.0%。在109例已发生pol基因耐药位点突变的病例中,整合酶基因突变率为3.7%,耐药率为2.8%。1例携带G118R、E138K、R263K突变,对埃替格韦、拉替拉韦、多替拉韦及比卡格韦均高度耐药。结论辽宁地区艾滋病抗病毒治疗失败患者中已出现pol基因及整合酶基因同时耐药情况,需加强治疗失败病例耐药监测。Objective To explore the characteristics of genotypic drug resistance for protease-reverse transcriptase and integrase gene among HIV-1 infections with virological failure after antiretroviral therapy(ART)in Liaoning province.Methods The plasma samples were collected from 267 cases with HIV/AIDS in 2019,with more than 6 months’ART,the viral loads≥1000 copies/ml.pol genotypic drug resistance detection was proceeded,then the integrase genotype resistance was further tested in the resistant patients.The pol gene and integrase gene sequences were submitted to Stanford University HIV drug resistance database for the interpretation of mutations and drug resistance.Results Among 267 cases,the rate of drug resistance gene mutation was 40.8% for pol gene.The main drug resistance mutations were G190,K65 and M184,and the mutation rate was 17.6%,16.1% and 12.7%,respectively.The drug resistance rate of protease inhibitors(PIs),nucleoside reverse transcriptase inhibitors(NRTIs)and non-nucleoside reverse transcriptase inhibitors(NNRTIs)was 3.0%,25.8% and 33.0%,respectively.Among 109 pol gene genotypic drug resistance cases,integrase mutations were present in 3.7%,with a prevalence of drug resistance at 2.8%.One case carried integrase strand transfer inhibitor mutations of G118R,E138K and R263K,conveying resistance to elvitegravir,raltegravir,dolutegravir and bictegravirat.Conclusion Resistances had been found to RTIs and INSTIs in patients failing antiretroviral therapy in Liaoning.Drug resistance monitoring should be strengthened in those ART failure patients.

关 键 词：艾滋病 抗病毒治疗 病毒学失败 整合酶抑制剂 耐药 

分 类 号：R183[医药卫生—流行病学] R512.91[医药卫生—公共卫生与预防医学]