丽水市2020-2022年新报告HIV/AIDS患者HIV-1分子网络特征  

Molecular network characteristics of newly reported HIV/AIDS cases in Lishui City,Zhejiang Province,from 2020 to 2022

作　　者：陈晓蕾[1] 梅建华[1] 陶桃[1] 张海芳[1] 蓝黄琛 CHEN Xiaolei;MEI Jianhua;TAO Tao;ZHANG Haifang;LAN Huangchen(Lishui Disease Prevention and Control Center,Lishui 323000,Zhejiang,China)

机构地区：[1]丽水市疾病预防控制中心,浙江丽水323000

出　　处：《中国艾滋病性病》2024年第6期600-606,共7页Chinese Journal of Aids & STD

基　　金：丽水市科技计划项目(2023GYX17)。

摘　　要：目的 分析丽水市2020-2022年新报告HIV/AIDS患者分子网络特征,为精准干预提供参考。方法 收集2020-2022年新报告且未治疗的HIV/AIDS患者血样385份,反转录和巢式PCR扩增样本pol区基因并测序,采用MEGA7.0软件构建系统进化树分析亚型,Cytoscape3.9.0软件生成分子网络,Logistics回归模型对入网率的影响因素进行分析。结果 获得pol区基因序列366条,发现8种亚型和3种流行重组型,主要亚型为CRF08_BC(37.98%)、CRF01_AE(25.41%)、CRF07_BC(24.04%)。在1.2%为基因阈值,共形成40个分子簇,208条序列入网,入网率为56.83%。有6个分子簇含阳性暗娼,这6个簇中81.65%(89/109)患者与阳性暗娼基因距离阈值≤1.2%。7个有5个及以上节点的分子簇存在明显的地区聚集性,主要聚集在A县。最大簇由CRF08_BC构成,该簇含82例患者,其中有2例暗娼,簇内有66个患者(82.50%,66/80)与这2名暗娼基因距离阈值≤1.2%,该簇以男性(81.71%)、≥50岁(85.37%)、已婚(52.44%)、小学及以下(63.41%)、现住址以A县(91.46%)、非婚商业异性性行为史(75.61%)为主;2021年和2022年入簇的52例患者中,42例(80.77%)为本地感染;45例(86.54%)感染时间在2020年及以前,4例(7.69%)在2021年及以后感染。对进入网络的影响因素进行分析,多因素Logistics回归结果显示,CRF08_BC亚型相比于其他亚型更易入网(OR=7.794,95%CI:4.212~14.421)。结论 丽水市HIV传播来源多样化,传播簇地区聚集性明显,暗娼起关键传播作用。以暗娼为中心呈地区聚集性的最大分子传播簇仍在扩增,但该簇扩增主要是2020年及之前感染的患者被挖掘发现导致,这些患者从感染到确证的时间间隔长,不排除这些患者这期间已经造成新的传播。下一步需强化对关键聚集性病例的溯源,强化已发现病例的性伴推动工作和对商业性异性性行为的综合干预。Objective The study aimed to analyze the molecular network characteristics of newly reported HIV/AIDS cases in Lishui City from 2020 to 2022,in order to provide references for precision intervention.Methods A total of 385 blood samples were collected from newly reported and untreated HIV/AIDS patients from 2020 to 2022.The pol genes of the samples were amplified by reverse transcription and nested polymerase chain reaction,and then sequenced.A phylogenetic tree was constructed using MEGA 7.0 to analyze the subtypes.Cytoscape 3.9.0 was used to generate a molecular network for subtype transmission analysis factors affecting the network entry rate.Logistic regression model was employed to analyze factors associated with entering the network.Results Out of 385 specimens,366 pol gene sequences were successfully amplified.Eight subtypes and three circulating recombinant forms(CRFs)were identified.The dominant subtypes were CRF08_BC(37.98%),CRF01_AE(25.41%),and CRF07_BC(24.04%).With a genetic distance threshold of 1.2%,40 molecular clusters were formed,and 208 sequences entered the network,resulting in a network entry rate of 56.83%.Notably,six clusters contained individuals who were positive for HIV and identified as female sex workers.Within these six clusters,81.65%(89/109)of the patients had a genetic distance threshold≤1.2%from positive female sex workers.Furthermore,seven molecular clusters with five or more nodes showed clear regional aggregation,primarily in County A.The largest cluster,consisting mainly of CRF08_BC,included 82 patients,66(82.50%)had a genetic distance threshold≤1.2%from the two positive sex workers.The main characteristics of patients in this cluster included:male(81.71%),age≥50 years old(85.37%),married(52.44%),education level of primary school or below(63.41%),current address in County A(91.46%),and a history of non-marital commercial heterosexual activity(75.61%).Among the 52 patients admitted to the cluster in 2021 and 2022,42(80.77%)were locally infected.Additionally,45(86.54%)were i

关 键 词：艾滋病病毒毒株亚型 分子传播网络 基因距离阈值 精准干预 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]