江苏省艾滋病治疗后高/低病毒血症病人的基因型耐药特征分析  

Characteristics of genetic drug resistance among AIDS patients with high/low level of viremia after treatment in Jiangsu Province

作　　者：周莹[1] 卢静[1] 徐晓琴[1] 张之[1] 孙琦 胡海洋[1] Zhou Ying;Lu Jing;Xu Xiaoqin;Zhang Zhi;Sun Qi;Hu Haiyang(Department of STD and AIDS Prevention and Control,Jiangsu Provincial Center for Disease Prevention and Control,Nanjing 210009,China)

机构地区：[1]江苏省疾病预防控制中心性病与艾滋病防制所,南京210009

出　　处：《国际病毒学杂志》2024年第1期53-57,共5页International Journal of Virology

摘　　要：目的了解江苏省艾滋病抗病毒治疗高病毒血症(high-level viremia,HLV)与低病毒血症(low-level viremia,LLV)病人的基因型耐药特征.方法收集2021年抗病毒治疗满6个月,血浆病毒载量≥50拷贝/毫升的样本,按50~999拷贝/毫升、≥1000拷贝/毫升分为LLV组和HLV组.In-house PCR方法扩增HIV-1 pol区蛋白酶和反转录酶区,并测序获取序列进行耐药突变分析和亚型鉴定.结果LLV组242人,耐药率为40.50%;HLV组598人,耐药率为51.34%.LLV组和HLV组亚型均以CRF01_AE和CRF07_BC为主,LLV组占比为38.84%和35.12%,HLV组占比为44.82%和22.75%,亚型构成有统计学差异.LLV组和HLV组蛋白酶耐药突变位点分别以M46(42.86%)和L33(28.57%)为主,核苷类反转录酶耐药突变位点均以M184(45.97%,31.92%)为主,非核苷类反转录酶耐药突变位点均以K103(26.14%%,23.56%)为主.两组耐药类别均以核苷类反转录酶抑制剂与非核苷类反转录酶抑制剂的复合型耐药为主,其次是非核苷类反转录酶抑制剂的单独耐药.结论应增加对艾滋病抗病毒治疗低病毒血症病人的耐药检测,及时发现耐药并逆转抗病毒治疗失败,以遏制艾滋病毒传播.Objective To investigate the characteristics of genotypic drug resistance among AIDS patients with high-level viremia(HLV)and low-level viremia(LLV)after antiviral treatment in Jiangsu province.Methods Blood samples were collected from patients receiving antiviral therapy(ART)over 6 months in 2021 with the viral load in plasma>50 copies/ml..The patients were divided into LLV group and HLV group according to the viral load of 50-999 copies/ml and≥1000 copies/ml.The segments of protease and reverse transcriptase regions in pol gene of human immunodeficiency virus 1(HIV-1)were amplified with an in-house PCR method.The products were sequenced for drug resistance mutation analysis and typing.to analysis drug resistance mutations and subtypes determination.Results The drug resistant rate in LLV was 40.5%among 242 LLV patients,and the rate was 51.34%in the 598 HLV patients.The dominant subtypes in both LLV and HLV groups were CRF01_AE and CRF07_BC.Both subtypes accounted for 38.84%and 35.12%in LLV group,44.82%and 22.75%in HLV group.The difference in the constitutions of subtypes was statistically significant.The dominant mutations in protease region were M46(42.86%)and L33(28.57%)in LLV and HLV groups,respectively.The main mutations in nucleotide and non-nucleotide reverse transcriptase regions in both groups were M184(45.97%,31.92%)and K103(26.14%,23.56%),respectively.The main types of drug resistance in both groups were mixed-type resistance followed by single-type resistance.The resistance to nucleoside reverse transcriptase inhibitors with non-nucleoside reverse transcriptase inhibitors was dominant in both LLV and LLV,followed by the resistance to single non-nucleoside reverse transcriptase inhibitors.Conclusions The drug resistance tests in AIDS patients with LLV after ART should be enhanced for early detection of drug resistance and ART failure,thus to block HIV transmission,HIV patients with low viremia to find out drug resistance and reverse the failure of antiretroviral therapy timely in order to end spread

关 键 词：艾滋病毒 低病毒血症 高病毒血症 基因型耐药 病毒抑制 

分 类 号：R512.91[医药卫生—内科学]