厦门市新发现HIV-1感染者分子流行病学及原发性耐药分析  

Molecular epidemiological and primary drug resistant analysis of newly discovered HIV-1 infections in Xiamen City

作　　者：张荣秋[1] 温娟 邱艺燕 张建梅[1] ZHANG Rong-qiu;WEN Juan;QIU Yi-yan;ZHANG Jian-mei(Xiamen Municipal Center for Disease Control and Prevention,Xiamen,Fujian 361000,China;不详)

机构地区：[1]厦门市疾病预防控制中心,福建厦门361000 [2]厦门市集美区疾病预防控制中心

出　　处：《中国卫生检验杂志》2022年第22期2698-2701,2705,共5页Chinese Journal of Health Laboratory Technology

基　　金：厦门市重点专科建设项目资助厦卫科教[2021]215号。

摘　　要：目的了解厦门市新发现HIV-1感染者的HIV-1亚型的型别,进而了解亚型变化以及传播途径,分析其原发性耐药情况。方法收集新发现HIV-1感染者的血浆样品,用罗氏公司的Tanman48进行实时荧光定量PCR测定HIV病毒载量,提取HIV病毒RNA,采用巢式PCR方法扩增gag-pol和env区基因片段、测序,进行分子流行病学分析和耐药基因型分析。结果85例Gag-pol与各亚型标准序列构建的系统进化树显示,CRF01_AE重组型为76例(89.41%),CRF07_BC重组型为5例(5.88%),CRF08_BC重组型为2例(2.35%),B’亚型为2例(2.35%)。共有4例耐药位点突变,原发性耐药率为4.68%。在4例原发性耐药标本中,PIs相关突变株1株,主要突变位点为M46I/L,表现为对NFV中度耐药和对LPV/r、FPV/r、ATV/r潜在耐药;NRTIs相关突变株1例,主要突变位点为D67N和L74V,表现为对ABC中度耐药和对AZT低度或者潜在耐药;NNRTIs相关突变株2例,主要突变位点为V179E和E138A,表现为对EFV、NVP、ETR潜在耐药和对RPV低度或者潜在耐药。结论厦门市新发现HIV感染者以CRF07_BC流行重组型为主,该人群中原发性耐药属于低流行区,但是原发性耐药已经开始传播,应参照原发性耐药检测为新发现HIV-1感染者制定首选治疗方案。Objective To analyze the HIV-1 subtype and primary drug resistance of newly reported HIV-1 infections in Xiamen City,so as to understand the subtype change and the way of transmission.Methods Blood samples of newly reported HIV-1 patients were collected.Real-time fluorescence quantitative PCR of Roche Tanman 48 was used to determine viral load of HIV.The RNA of HIV virus was extracted,and the gag-pol and env gene fragments were amplified by nested PCR and sequenced for molecular epidemiological analysis and drug resistance genotype analysis.Results The phylogenetic tree constructed with 85 cases of gag-pol and standard sequences of subtypes showed that 76 cases of CRF01_AE(89.41%),5 cases of CRF07_BC(5.88%),2 cases of CRF08_BC(2.35%)and 2 cases of subtype B’(2.35%)were observed.There were 4 cases of drug resistance site mutation,and the primary drug resistance rate was 4.68%.Among the 4 primary drug resistance samples,1 PIs-related mutant was found,and the main mutation site was M46 I/L,showing moderate resistance to NFV and potential resistance to LPV/r,FPV/r and ATV/r.One case of NRTIs-related mutant was observed,the main mutation sites were D67 N and L74 V,showing moderate resistance to ABC and low or potential resistance to AZT.There were 2 NNRTIs-related mutants,the main mutation sites were V179 E and E138 A,which showed potential resistance to EFV,NVP and ETR,and low or potential resistance to RPV.Conclusion In general,the new HIV infection in Xiamen City is mainly in CRF07_BC.The rate of the primary drug resistance mutation of the newly reported HIV-1 patients was low.However,primary drug resistance has begun to spread,and primary drug resistance testing should be used to develop the first choice of treatment for newly identified HIV-1 infection.

关 键 词：新发现HIV-1感染者 HIV-1亚型 原发性耐药 基因突变 

分 类 号：R446[医药卫生—诊断学]