云南省HIV-1 CRF01_AE毒株基因型耐药研究  

Genotypic drug-resistance of HIV-1 CRF01_AE in Yunnan

作　　者：张芮 刘家法 张米 李健健 邓雪媚 马莎 李梦学 董兴齐 ZHANG Rui;LIU Jia-fa;ZHANG Mi;LI Jian-jian;DENG Xue-mei;MA Sha;LI Meng-xue;DONG Xing-qi(School of Public Health,Kunming Medicine University,Kunming,Yunnan 650000,China;Department of Laboratory,Yunnan Provincial Infectious Diseases Hospital,Kunming,Yunnan 650301,China)

机构地区：[1]昆明医科大学公共卫生学院,云南昆明650000 [2]云南省传染病医院检验科,云南昆明650301

出　　处：《中国热带医学》2022年第7期597-602,628,共7页China Tropical Medicine

基　　金：云南省重大科技专项计划(No.202102AA310005);云南省高层次卫生技术人才培养经费资助项目(No.H-2019047)。

摘　　要：目的 了解云南省HIV-1 CRF01_AE毒株的流行分布及基因型耐药情况。方法 收集2018—2021年云南省抗病毒治疗失败的HIV/AIDS患者的人口学资料,采集患者血浆,逆转录聚合酶链反应扩增HIV-1 pol基因蛋白酶和逆转录酶区并进行序列测定,对基因型为CRF01_AE的序列进行耐药情况分析。结果 通过基因型耐药检测共获得967例亚型为CRF01_AE序列,其中男性682例(占70.5%),耐药509例,耐药率为52.6%,异性性传播813例(占84.1%),同性性传播95例(占9.8%)。同性性传播的耐药率最高,为65.3%;治疗时长<12个月的耐药率最低,为35.9%,36~<48个月耐药率最高,为58.1%。核苷类反转录酶抑制剂(NRTIs)耐药率为33.9%,非核苷类反转录酶抑制剂(NNRTIs)的耐药率为48.5%,蛋白酶抑制剂(PIs)的耐药率较低为1.3%。NRTIs类药物中阿巴卡韦(ABC)、恩曲他滨(FTC)和拉米夫定(3TC)耐药率较高,分别为为32.9%、32.4%和32.4%;NNRTIs类药物中奈韦拉平(NVP)和依非韦仑(EFV)耐药率较高,分别为47.6%和47.5%,均以高度耐药为主。一线治疗方案耐药率56.2%高于二线治疗方案耐药率29.5%,差异有统计学意义(P<0.001)。NRTIs耐药突变位点中,以M184V/I突变位点为主,突变率为30.0%;NNRTIs耐药突变位点中,以K103N/Q/S突变位点为主,突变率为28.1%;PIs耐药位点突变率相对较低,主要的耐药突变位点是L33F,突变率为3.7%。结论 云南省抗病毒治疗失败亚型CRF01_AE的患者耐药率有所降低,但部分地区及人群的耐药率仍较高,应加强对重点地区和人群的管理,加强耐药监测,对治疗失败的患者及时掌握耐药情况,合理调整治疗方案。Objective To study the prevalence distribution and genotypic drug-resistance of HIV-1 CRF01_AE in Yunnan Province.Methods The demographic data and plasma of HIV/AIDS patients who failed antiviral treatment in Yunnan Province from 2018 to 2021 were collected.The HIV-1 pol gene protease and the reverse transcriptase region were amplified using the reverse transcriptase chain reaction and the sequences were determined.Drug-resistance of the CRF01_AE subtype was analyzed.Results In this study,a total of 967 subtype sequences of CRF01_AE were obtained through genotype resistance detection.The resistance rate in this population was 52.6%,509 cases.Among them,the gender was dominated by men which was 70.5%,682 cases,and the main route of transmission was heterosexual transmission which was 84.1%,813cases.Homosexual transmission accounted for 9.8%,95 cases,however,the drug resistance rate of homosexual transmission was 65.3% which was the highest among several modes of transmission.The drug resistance rate was lowest (35.9%) when the treatment duration was less than 12 months,and the drug resistance rate was the highest (58.1%) when the treatment duration was 36-<48 months.The resistance rate of nucleoside reverse transcriptase inhibitors (NRTIs) was 33.9%,the rate of nonnucleoside reverse transcriptase inhibitors (NNRTIs) was 48.5%,and the rate of protease inhibitors (PIs) was 1.3%.Among NRTIs,the drug resistance rates of abacavir (ABC),emtricitabine(FTC) and lamivudine (3TC) were higher,which were 32.9%,32.4% and 32.4%respectively.Among NNRTIs,nevirapine (NVP) and efavirenz (EFV) had higher drug resistance rates,which were 47.6% and 47.5%respectively,and they were mainly high-level drug resistance.The drug resistance rate of first-line treatment (56.2%) was higher than that of second-line treatment (29.5%).M184V/I was the main drug resistance mutation site in NRTIs,and the mutation rate was 30.0%.K103N/Q/S was the main drug resistance mutation site in NNRTIs,and the mutation rate was 28.1%.The mutation rate of PIs drug

关 键 词：HIV-1 CRF01_AE 基因型耐药 治疗方案 

分 类 号：R512.91[医药卫生—内科学]