昆明市2020—2022年新发现HIV-1感染者传播性耐药和首次CD4^(+)T淋巴细胞计数分析  

Transmitted Drug Resistance and the First CD4^(+)T Lymphocyte Count Analysis of HIV-1 Infected Patients in Kunming from 2020 to 2022

作　　者：吴智星 刘家法 杨翠先 李健健 张米 邓雪媚 马莎 王佳丽 程鹏 董兴齐 WU Zhixing;LIU Jiafa;YANG Cuixian;LI Jianjian;ZHANG Mi;DENG Xuemei;MA Sha;WANG Jiali;CHENG Peng;DONG Xingqi(Department of Clinical Laboratory,Yunnan Provincial Infectious Diseases Hospital,Kunming 650301,China;School of Public Health,Kunming Medical University,Kunming 650000,China)

机构地区：[1]云南省传染病医院检验科,云南昆明650301 [2]昆明医科大学公共卫生学院,云南昆明650000

出　　处：《中国皮肤性病学杂志》2024年第10期1131-1140,共10页The Chinese Journal of Dermatovenereology

基　　金：云南省高层次卫生技术人才培养经费资助项目(H-2019047);云南省科技厅重大科技专项计划(202102AA310005);云南省科技厅昆明医科大学应用基础研究联合专项基金项目(202201AY070001-208,202101AY070001-223);昆明医科大学科技创新团队建设项目(CXTD202111)。

摘　　要：目的了解昆明市HIV-1传播性耐药情况及首次CD4^(+)T淋巴细胞计数,为制定抗病毒治疗方案提供参考依据。方法选取现住址为昆明市且新发现的HIV/AIDS患者,采集血浆,扩增pol区基因序列,进行基因型判定、耐药突变和CD4^(+)T淋巴细胞分析。结果共成功获取647条HIV-1 pol基因序列,其中基因型以URFs为主(29.37%),其次为CRF08_BC(26.28%)和CRF07_BC(16.54%)。647例感染者以男性为主(77.43%),50岁及以上占比最多(32.15%),传播途径以异性传播为主(56.88%);性别、文化程度、传播途径和基因亚型为耐药的影响因素(P<0.05);昆明市HIV/AIDS患者传播性耐药率为11.75%,核苷类反转录酶抑制剂(NRTIs)、非核苷类反转录酶抑制剂(NNRTIs)、蛋白酶抑制剂(PIs)和整合酶抑制剂(INSTIs)耐药率分别为0.77%、7.73%、3.40%和0.31%;NRTIs、NNRTIs、PIs和INSTIs耐药位点突变率分别为2.16%、19.47%、3.86%和1.39%;首次CD4^(+)T淋巴细胞计数以200~350个/μL为主,占29.37%,其次为<200个/μL,占27.82%,晚发现率为30.91%。结论昆明市HIV-1传播性耐药处于中度耐药水平,以NNRTIs相关耐药为主,未在昆明市广泛使用的INSTIs类药物也出现了耐药;同时,昆明市晚发现比例较高,应加强艾滋病宣传工作,扩大检测面,尽早发现病例,提高患者生命质量并减少传播。Objective To investigate the status of HIV-1 transmitted drug resistance and the first T lymphocyte count in Kunming city,and to provide reference for antiviral treatment.Methods Newly discovered HIV/AIDS patients living in Kunming were selected,plasma was collected,gene sequence in pol region was amplified,genotype determination,drug resistance mutation and CD4^(+)T lymphocyte analysis were performed.Results A total of 647 HIV-1 pol gene sequences were obtained.The most of them are URFs subtype(29.37%),and then CRF08_BC subtype(26.28%)and CRF07_BC subtype(16.54%)respectively.Most of them were male(77.43%),50 years old and above accounted for the largest proportion(32.15%),and the main transmission route was heterosexual transmission(56.88%).Gender,education level,transmission route and gene subtype were the influencing factors of drug resistance(P<0.05).The transmited drug resistance rate of HIV/AIDS patients was 11.75%,and the resistance rates of nucleoside reverse transcriptase inhibitors(NRTIs),non-nucleoside reverse transcriptase inhibitors(NNRTIs),protease inhibitors(PIs)and integrase inhibitors(INSTIs)were 0.77%,7.73%,3.40%and 0.31%,respectively.The mutation rates of NRTIs,NNRTIs,PIs and INSTIs resistance sites were 2.16%,19.47%,3.86%and 1.39%,respectively.The first CD4^(+)T lymphocyte count was mainly 200-350 cell/μL,accounting for 29.37%,followed by<200 cell/μL,accounting for 27.82%,and the late detection rate was 30.91%.Conclusion The transmitted drug resistance of HIV-1 in Kunming is at the moderate level,and NNRTIs related drug resistance is the main factor.The INSTIs drugs that not widely used in Kunming are also resistant,while Kunming city has a high proportion of late detection.We should strengthen AIDS publicity work,expand the detection scope,and detect cases as early as possible,in order to improve patients quality of life and reduce transmission.

关 键 词：HIV-1 新发现 耐药 T淋巴细胞 

分 类 号：R512.91[医药卫生—内科学]