HIV耐药毒株传播的监测  

Surveillance of HIV transmitted drug resistance

作　　者：李韩平 李林 李敬云 LI Hanping;LI Lin;LI Jingyun(Institute of Microbiology and Epidemiology,Institute of Military Medicine,Academy of Military Sciences,National Key Laboratory of Pathogenic Microbial Biosafety,Beijing 100071,China)

机构地区：[1]军事科学院军事医学研究院微生物流行病研究所,病原微生物生物安全全国重点实验室,北京100071

出　　处：《中国热带医学》2024年第1期6-11,共6页China Tropical Medicine

基　　金：国家重点研发计划项目(No.2022YFC2305202,No.2022YFC2304903)。

摘　　要：传播性耐药(transmitted drug resistance,TDR)指HIV耐药毒株的感染,在没有抗逆转录病毒(antiretroviral,ARV)药物暴露史的患者中检出耐药,将影响一线抗病毒治疗及暴露前后预防的效果,是实现艾滋病防治目标的重大现实威胁。耐药毒株适应性的改变是决定其传播风险的根本性生物学因素,影响监测人群选择、从感染到耐药检测时间的确定及检测方法的应用;传播性耐药突变的定义和分类是获得准确监测结果的关键。本文介绍了近年来耐药毒株的适应性、监测的耐药突变、监测人群选择等方面的研究进展,提出了我国TDR监测应重点开展的工作,包括建立适合我国毒株特点的监测耐药突变、建立和使用高分辨测序方法准确鉴定混合碱基、实现TDR监测的规范化等,从而为准确获得TDR监测结果,有效遏制耐药毒株的传播提供科技支撑。Human immunodeficiency virus(HIV)transmitted drug resistance(TDR)means the infection of HIV drugresistant strains,which are detected in patients without a history of exposure to antiretroviral(ARV)drugs.TDR has the potential to reverse the effectiveness of first-line antiretroviral therapy,pre-exposure prophylaxis(PrEP),and post-exposure prophylaxis(PEP),and is the practical major threat to the realization of the targets for HIV prevention and control.The changes in fitness of HIV DR strains are the basic biological factor challenging the risk of its transmission,and related to the selection of the survey population,the determination of the time span between diagnosis of HIV infection and testing of DR,and the application of DR test assay.The integrated definition and interpretation of surveillance drug resistance mutations(SDRMs)is the key to obtaining accurate surveillance results.This article reviews the recent progress in research on the fitness of HIV DR strains,identification of SDRMs,and the selection of surveillance population.It also proposes key areas for TDR monitoring in China,including the development of SDRMs list tailored to the characteristics of Chinese strains,high-resolution sequencing to accurately identify mixed base pairs,and the standardization of TDR monitoring.These efforts will provide scientific support for accurate TDR monitoring results and effective containment of the transmission of drug-resistant strains.

关 键 词：传播性耐药 监测 耐药突变 适应性 

分 类 号：R512[医药卫生—内科学]