2020-2023年南宁市新报告HIV感染/AIDS患者亚型特征及耐药分析  

Subtype characteristics and drug resistance analysis of newly reported patients with HIV/AIDS before antiviral treatment in Nanning,2020-2023

作　　者：李雪花 刘洁 黄金萍[3] 卢焕 刘欣 覃秋珍 李杨平 叶力[1,2] 黎彦君 Li Xuehua;Liu Jie;Huang Jinping;Lu Huan;Liu Xin;Qin Qiuzhen;Li Yangping;Ye Li;Li Yanjun(School of Public Health,Guangxi Medical University,Guangxi Nanning 530013,China;Guangxi Key Laboratory of AIDS Prevention and Treatment,Life Sciences Institute,Guangxi Medical University,Guangxi Nanning 530021,China;Infectious Diseases Department,The Fourth People's Hospital of Nanning,Guangxi Nanning 530013,China)

机构地区：[1]广西医科大学公共卫生学院,广西南宁530013 [2]广西医科大学生命科学研究院广西艾滋病防治研究重点实验室,广西南宁530021 [3]南宁市第四人民医院感染内科,广西南宁530013

出　　处：《新发传染病电子杂志》2024年第5期8-13,共6页Electronic Journal of Emerging Infectious Diseases

基　　金：国家科技专项子课题(2022YFC2601600);广西自然科学基金青年基金(2023GXNSFBA026264);广西壮族自治区卫生健康委自筹经费科研课题(Z-A20231220)。

摘　　要：目的分析南宁市2020-2023年新报告HIV感染/AIDS患者的HIV-1亚型特征和耐药流行情况,为制定该地区的AIDS防控策略提供参考依据。方法收集2020年1月至2023年12月南宁市新确诊且尚未开展抗反转录病毒治疗(antiretroviral therapy,ART)的HIV感染/AIDS患者的全血标本374份进行HIV-1分型及耐药检测。提取HIV核酸并经过反转录后,以巢式PCR对HIV-1 pol区基因扩增并进行Sanger测序,根据斯坦福大学HIV db Program耐药数据库等工具对序列信息进行分析。结果HIV基因序列的PIs区、RT区、IN区扩增成功的有346例,28例未成功扩增。共检出9种亚型,以CRF01_AE亚型(29.48%)和B/C重组亚型(27.46%)为主。不同性别感染者和不同性途径传播感染者的总体亚型分布均不同(P<0.05)。ART前耐药率达8.09%(28/346),其中核苷类反转录酶抑制剂(nucleoside reverse transcriptase inhibitors,NRTIs)耐药率为2.89%,非核苷类反转录酶抑制剂(non-nucleoside reverse transcriptase inhibitors,NNRTIs)耐药率为3.75%,蛋白酶抑制剂(protease inhibitors,PIs)耐药率为1.73%,整合酶抑制剂(integrase inhibitors,INSTIs)耐药率为0.29%。总耐药基因位点突变率为22.83%(79/346)。总耐药基因位点突变率为22.83%(79/346),针对NRTIs、NNRTIs、PIs和INSTIs的耐药位点突变率分别为4.91%、15.32%、2.02%和2.31%。结论南宁市新报告HIV感染/AIDS患者感染HIV-1主要为CRF01_AE亚型,ART前耐药率已达中高水平,且出现了INSTIs耐药毒株,应加强对不同人群HIV-1亚型的流行监测及新报告HIV感染/AIDS患者ART前的耐药监测。Objective To analyze the prevalence of HIV-1 genotypes and the transmitted drug resistance in HIV/AIDS patients before antiviral treatment from 2020 to 2023 in Nanning City,provide a reference for the development of prevention and control strategies for newly reported HIV infections in the region.Method 374 whole blood specimens from newly confirmed non-ART HIV/AIDS patients in Guangxi from January 2020 to December 2023 were collected for HIV-1 drug resistance testing.After extracted nucleic acids were reverse transcribed,the HIV-1 pol region gene was amplified by nested PCR and sequenced by Sanger sequencing,and the sequence information was analyzed according to tools such as the Stanford University HIVdb Program Drug Resistance Database.Result A total of 346 samples were successfully sequenced.Among them 9 subtypes were detected,mainly CRF01_AE subtypes and B/C recombinant,accounting for 29.48%and 27.46%.The subtype distribution between males and females was significantly different,and the subtype distribution in different sex-transmitted infections was also significantly different(P<0.05).The overall drug resistance rates of PDR was 8.09%(28/346)with 2.89%to NRTIs,3.75%to NNRTIs,1.73%to PIs,and 0.29%to INSTIs.The drug resistance mutation rate of genotypic subtypes was 22.83%(79/346),and the mutation rates of resistance sites for NRTIs,NNRTIs,PIs and INSTIs were 4.91%,15.32%,2.02%and 2.31%,respectively.Conclusion Newly reported patients with HIV infection/AIDS in Nanning City are mainly CRF01_AE subtype HIV-1 infections,meanwhile,the pre-ART resistance rate has reached a medium-high level,and INSTIs resistant strains have emerged.Surveillance of HIV-1 subtypes prevalence and the drug resistance monitoring of newly reported HIV-infected people before ART need to be strengthened.

关 键 词：艾滋病 抗病毒治疗前耐药 HIV-1亚型 耐药突变 

分 类 号：R52[医药卫生—内科学]