2020—2023年安徽省新报告HIV/AIDS人群病毒基因亚型及耐药监测结果的分析  

Analysis of virus gene subtypes and drug resistance monitoring results of newly reported HIV/AIDS population in Anhui Province from 2020 to 2023

作　　者：秦义组[1] 沈月兰[1] 刘爱文[1] 吴建军[1] 缪礼锋[1] 方琴 帅晨曦 金琳[1] Qin Yizu;Shen Yuelan;Liu Aiwen;Wu Jianjun;Miu Lifeng;Fang Qin;Shuai Chenxi;Jin Lin(Department of AIDS Prevention and Control,Anhui Center for Disease Control and Prevention,Hefei 230601,China)

机构地区：[1]安徽省疾病预防控制中心艾滋病防治科,合肥230601

出　　处：《中华预防医学杂志》2024年第8期1204-1212,共9页Chinese Journal of Preventive Medicine

基　　金：安徽省自然科学基金优青项目(2208085Y29);安徽省卫生健康科研项目(AHWJ2022b057)。

摘　　要：目的探讨安徽省2020—2023年新报告人类免疫缺陷病毒(HIV)感染者/艾滋病(AIDS)病毒基因亚型及耐药监测情况。方法采用观察性设计研究,收集2020年1月至2023年12月安徽省疾病预防控制中心艾滋病防治科确诊为HIV/AIDS的病例血样。采用反转录-巢式PCR技术扩增HIV-1pol基因,采用MEGA 7.0软件构建系统进化树分析确认基因亚型,耐药突变位点采用美国斯坦福大学HIV耐药数据库在线软件工具分析。多因素logistic分析治疗前耐药的影响因素。结果共收集335份病例血浆样本,成功获得332条HIV-1pol区基因序列,基因亚型以CRF01-AE型为主,占35.55%(118/332),其次为CRF07-BC型、B型、B+C型,分别占29.22%(97/332)、11.74%(39/332)、9.93%(33/332)。治疗前总耐药率为30.12%(100/332),其中治疗前HIV-1中蛋白酶抑制剂(PIs)类药物耐药率为6.33%(21/332);治疗前核苷类逆转录酶抑制剂(NRTI)类药物耐药率为6.33%(21/332);治疗前非核苷类逆转录酶抑制剂(NNRTI)类药物耐药率为17.47%(58/332)。不同药物类型耐药率对比,差异有统计学意义(χ^(2)=30.435,P<0.05)。100例耐药病例中,HIV-1蛋白酶抑制剂耐药突变点以Q58E为主[占21.00%(21/100)],核苷类逆转录酶抑制剂耐药突变点以M184V/I为主[占6.00%(6/100)];非核苷类逆转录酶抑制剂耐药突变点以K103N为主[22.00%(22/100)]。不同抗病毒治疗起始时间、基线CD4^(+)T细胞数、基因亚型的耐药率对比,差异有统计学意义(χ^(2)分别为24.152、32.516、11.652,P<0.05);多因素logistic分析结果显示,基线CD4^(+)T细胞数<200个/μl、B亚型、B+C亚型、CRF01-AE亚型、CRF55-01B亚型及01-BC亚型是治疗前耐药的影响因素(χ^(2)分别为4.577、8.202、4.416、5.206、7.603、4.804,P<0.05)。结论安徽省2020—2023年新报告HIV/AIDS人群病毒基因亚型多样,治疗前耐药基因突变主要以NNRTIs类为主,应重点关注基线CD4^(+)T细胞数、抗病毒治疗时间、基因亚型分布情况,以降�Objective To investigate the genetic subtypes and drug resistance monitoring of newly reported human immunodeficiency virus(HIV)infection/AIDS virus in Anhui Province from 2020 to 2023.Methods An observational design study was used to collect blood samples from patients diagnosed with HIV/AIDS in the AIDS Prevention and Control Department of Anhui Provincial Center for Disease Control and Prevention from January 2020 to December 2023.The HIV-1 pol gene was amplified by reverse transcription-nested PCR,and the genetic subtypes were identified by phylogenetic tree analysis using MEGA 7.0 software.The mutation sites of drug resistance were analyzed by the online software tool of Stanford University′s HIV Drug resistance database.The influencing factors of drug resistance before treatment were analyzed by multivariate logistic analysis.Results A total of 335 plasma samples were collected,and 332 HIV-1 pol gene sequences were obtained successfully.The main gene subtypes were CRF01-AE,accounting for 35.55%(118/332),followed by CRF07-BC,B and B+C types[29.22%(97/332),11.74%(39/332),9.93%(33/332)].The total drug resistance rate before treatment was 30.12%(32/100),and the drug resistance rate of protease inhibitor(PIs)in HIV-1 was 6.33%(21/332).The drug resistance rate of nucleoside reverse transcriptase inhibitors(NRTI)before treatment was 6.33%(21/332).The drug resistance rate of non-nucleoside reverse transcriptase inhibitors(NNRTI)before treatment was 17.47%(58/332).The comparison of drug resistance rate of different drug types showed statistical significance(χ^(2)=30.435,P<0.05).Among the 100 cases of drug resistance,the main mutation point of HIV-1 protease inhibitor was Q58E(21.00%),and the main mutation point of nucleoside reverse transcriptase inhibitor was M184V/I(6.00%).Non-nucleoside reverse transcriptase inhibitor resistance mutation points mainly K103N(22.00%).There were statistically significant differences in the starting time of antiviral therapy,the number of CD4^(+)T cells at baseline and the drug re

关 键 词：艾滋病病毒 艾滋病 基因亚型 治疗前 耐药 

分 类 号：R512.91[医药卫生—内科学]