安徽省阜阳市新报告HIV感染者耐药及分子传播网络研究  

Drug resistance and molecular transmission network of newly reported HIV infections in Fuyang,Anhui Province

作　　者：潘文婷 胡冰[3] 韦伟[3] 杨晓辉[3] 倪杰[3] 张进[4] 戴色莺[4] 沈月兰[4] 方琴 秦义组[4] 缪礼锋[4] 高南南 丁霞 吴建军 PAN Wenting;HU Bing;WEI Wei;YANG Xiaohui;NI Jie;ZHANG Jin;DAI Seying;SHEN Yuelan;FANG Qin;QIN Yizu;MIAO Lifeng;GAO Nannan;DING Xia;WU Jianjun(Anhui Medical Univeristy,Hefei 230032,China;Anhui No.2 Provincial People's Hospital,Hefei 230041;Fuyang Center for Disease Control and Prevention,Fuyang 236030;Anhui Provincial Center for Disease Control and Prevention,Hefei 230601)

机构地区：[1]安徽医科大学公共卫生学院,合肥230032 [2]安徽省第二人民医院,合肥230041 [3]阜阳市疾病预防控制中心,安徽阜阳236030 [4]安徽省疾病预防控制中心,合肥230601

出　　处：《中国艾滋病性病》2022年第12期1364-1369,共6页Chinese Journal of Aids & STD

基　　金：2021年度阜阳市卫生健康委项目(FY2021-067);安徽省医疗卫生重点专科建设项目支持。

摘　　要：目的分析安徽省阜阳市2020-2021年新报告HIV感染者主要亚型毒株的分子流行特征及传播网络情况,为当地制订有效的干预措施提供依据。方法2020年1月至2021年12月共收集阜阳市新报告感染HIV-1血液样本589份,扩增pol基因和测序,运用美国斯坦福大学耐药数据库进行耐药突变分析,构建系统进化树,提取传播网络并分析其特征,对研究对象进入网络的相关因素进行分析。结果成功扩增获得589名HIV感染者的pol区基因序列,主要的亚型为CRF07_BC(34.8%),B(30.4%)和CRF01_AE(22.4%),新报告感染者总体耐药率为8.6%。三个主要亚型分别以0.5%作为基因距离阈值构建了分子传播网络,入网率分别为B(41.3%)、CRF07_BC(34.6%)和CRF01_AE(20.5%)。对进入网络的影响因素进行分析,多因素Logistic回归结果显示,年龄>50岁(与<30岁相比,a OR=2.419,95%CI:1.189~4.921)、CRF07_BC(与CRF01_AE相比,a OR=1.875,95%CI:1.085~3.242)、B亚型(与CRF01_AE相比,a OR=1.954,95%CI:1.086~3.513)和CD4细胞计数在200~500个/μL者(与<200个/μL者相比,a OR=2.155,95%CI:1.296~3.582)、耐药(与不耐药相比,a OR=5.142,95%CI:2.383~11.095)更容易进入网络。结论阜阳市新报告HIV感染者耐药率较高,并形成了耐药传播簇。通过构建分子传播网络,识别出当地农村地区文化程度较低的老年人群应为重点干预对象。Objective To analyze the molecular epidemic characteristics and transmission network of the main subtypes of HIV infection newly reported from 2020-2021 in Fuyang City,Anhui Province,and to provide evidence for formulating effective local intervention measures.Methods From January 2020 to December 2021,589 blood samples of HIV-1 infected new reported in Fuyang were collected and pol gene was amplified and sequenced.Drug resistance mutation analysis was performed using Stanford University Drug Resistance Database.The phylogenetic tree was constructed.The transmission network was extracted and its characteristics were analyzed.The related factors of entering the network were analyzed.Results The pol region gene sequences of 589 HIV-infected patients were successfully amplified.The main subtypes were CRF07BC(34.8%),B(30.4%),and CRF01AE(22.4%).The overall drug resistance rate of newly reported HIV-infected patients was 8.6%.Molecular transmission networks were constructed using 0.5%as the gene distance threshold for the three main subtypes.The network access rates were B(41.3%),CRF07BC(34.6%),and CRF01AE(20.5%).Multivariate logistic regression showed that age>50 years(a OR=2.419,95%CI:1.189-4.921,compared with<30 years),CRF07BC(a OR=1.875,95%CI:1.085-3.242,compared with CRF01AE),subtype B(a OR=1.954,95%CI:1.086-3.513,compared with CRF01AE)and CD4 cell count 200-500 cells/μL(a OR=2.155,95%CI:1.296-3.582,compared with<200 cells/μL),drug resistance(a OR=5.142,95%CI:2.383-11.095,compared with no drug resistance)were more likely to enter the network.Conclusions The drug resistance rate of newly reported HIV infection in Fuyang is high and drug resistance transmission clusters are formed.By constructing molecular transmission networks,it was identified that elderly populations with lower education levels in local rural areas should be targeted for focused intervention.

关 键 词：艾滋病病毒 分子传播网络 耐药 

分 类 号：R373.9[医药卫生—病原生物学]