2019—2021年西昌市HIV-1感染者治疗前耐药性分析  

Analysis of pre-treatment drug resistance of HIV-1 infected individuals in Xichang 2019 to 2021

作　　者：李玲 殷俊 梁姝[1] 李一平 周玚 苏玲[1] 杨洪[1] 叶黎[1] 张燕 袁丹[1] LI Ling;YIN Jun;LIANG Shu;LI Yi-ping;ZHOU Chang;SU Ling;YANG Hong;YE Li;ZHANG Yan;YUAN Dan(Sichuan Center for Disease Control and Prevention,Chengdu 610041,Sichuan Province,China.;Xichang Center for Disease Control and Prevention,Xichang 513401,Sichuan Province,China.)

机构地区：[1]四川省疾病预防控制中心,成都610041 [2]西昌市疾病预防控制中心,四川西昌513401

出　　处：《预防医学情报杂志》2022年第12期1529-1534,1540,共7页Journal of Preventive Medicine Information

基　　金：四川省卫生与健康委员会科研课题-四川省艾滋病耐药患者二线方案治疗效果及耐药性研究(项目编号:20PJ121);四川省科技厅科研课题-四川凉山州艾滋病防治攻坚关键技术研究(项目编号:2020YJ0449)。

摘　　要：目的分析2019—2021年凉山彝族自治州西昌市新报告的抗病毒治疗前的HIV-1感染者的耐药情况及其分子网络特征,为制定更科学有效的治疗方案提供参考。方法采集西昌市2019—2021年新报告的抗病毒治疗前的HIV-1感染者的血浆样本,采用巢式PCR扩增HIV-1 pol基因区的蛋白酶及逆转录酶区并进行耐药分析,使用卡方检验分析各变量的耐药发生差异,并应用HyPhy2.2.4与Cytoscape3.6.1软件对基因序列构建分子网络分析耐药传播特征。结果在764样本中获得703条有效分析序列,有72例(10.24%)出现了耐药突变。职业、感染途径和感染病毒亚型的耐药率差异均有统计学意义(P均<0.05)。分子传播网络分析发现当基因距离为0.007时,成簇数最多。有134例(19.0%)基因序列进入分子网络,形成36个簇。其中最大的簇包含44条序列,均为CRF07_BC。有1个耐药簇,是以Q58E为耐药突变位点的5位年轻男性。此外,1个包含10条序列的CRF08_BC亚型簇中出现6例均为E138Q+V179D耐药位点的病例。结论西昌市治疗前患者耐药率已达到中等水平,具有耐药毒株传播风险,需加强当地耐药监测,及时根据耐药情况调整治疗方案,同时运用分子传播网络方法以加强对耐药分子簇的干预。Objective To anlyze the drug resistance and characteritics of molecular network of human immunodeficiency virus(HIV)infected individuals who were newly dignosed and without initial antiretroviral therapy(ART)in Xichang city,Liangshan prefecture during 2019-2021,and to provide a reference for formulating a more scientific and effective treatment plan.Methods The plasma samples were collected,which were from newly dignosed HIV-1 infected persons who did not receive antiviral treatment in Xichang city during 2019-2021.The protease and reverse transcriptase fragments of HIV-1 pol gene region were amplified by Nested PCR and the differences of drug resistance among variables was also analyzed by Chi-square test.Molecular network was constructed by using HyPhy 2.2.4 and Cytoscape 3.6.1 software.Results 703 sequences were successfully obtained from 764 samples,and 72 samples(10.24%)had drug-resistant mutations.The differences of drug resistance rates among occupation,infection way and genotype subtypes were statistically significant(P<0.05).Molecular propagation network analysis showed that when the gene distance was 0.007,the number of clusters was the largest.The molecular network contained 134(19.0%)sequences and 36 clusters.And the largest cluster contained 44 sequences and all subtypes were CRF07_BC.Moreover,there was a drug resistance cluster,which included five young men with Q58E as the drug resistance mutation site.In addition,there was a CRF08_BC cluster included 10 sequences,6 sequences of which had E138Q+V179D resistance mutation sites.Conclusions Pre-treatment drug resistance(PDR)of Xichang city has reached the medium level,with the risk of transmission of drug-resisitant strains.It is necessary to strengthen monitoring of the local drug resistance,timely adjust the best treatment according to the level of drug resistance.Meanwhile,strengthening the intervention of molecular clusters of drug resistance by molecular propagation network.

关 键 词：人类免疫缺陷病毒1型(HIV-1) 治疗前耐药(PDR) 耐药 分子传播网络 

分 类 号：R512.91[医药卫生—内科学]