杭州市新确诊HIV-1感染者独特重组毒株流行情况分析  

Epidemiological analysis of unique recombinant strains in newly diagnosed HIV-1 patients in Hangzhou

作　　者：叶灵 许珂[1] 罗文杰[1] 张兴亮[1] 吴嗣圣 朱敏 尤佳女 Ye Ling;Xu Ke;Luo Wenjie;Zhang Xingliang;Wu Sisheng;Zhu Min;You Jia′nyu(Institute for AIDS/STD Prevention and Treatment,Hangzhou Center for Disease Control and Prevention(Hangzhou Institute of Public Health Supervision),Hangzhou 310002,China)

机构地区：[1]杭州市疾病预防控制中心(杭州市卫生监督所)艾滋病性病防制所,杭州310002

出　　处：《中华微生物学和免疫学杂志》2024年第11期958-964,共7页Chinese Journal of Microbiology and Immunology

基　　金：杭州市医药卫生科技项目(20220919Y062);杭州市医学重点学科(感染性疾病学);浙江省医药卫生科技计划项目(2022KY1041)。

摘　　要：目的了解杭州市新报告HIV-1感染者独特重组型(unique recombinant forms,URFs)毒株分子流行特征,为艾滋病防控提供理论支持。方法收集杭州市2019—2023年新确诊且未经抗病毒治疗HIV-1感染病例血样,通过逆转录和巢式PCR扩增HIV-1 pol区基因并测序。通过系统进化树筛选URFs毒株,并对其进行重组分析。计算URFs序列间遗传距离并构建分子网络。使用校正群体耐药分析程序(Calibrated Populatin Resistance,CPR)分析传播性耐药突变。结果获得222条URFs毒株pol基因序列,占5.0%(222/4471),重组类型分别为CRF01_AE/CRF07_BC(60.4%,134/222)、CRF01_AE/C(11.7%,26/222)、CRF01_AE/B(9.5%,21/222)、CRF01_AE/B/C(8.1%,18/222)、B/C(7.6%,17/222)和CRF55_01B/CRF07_BC(2.7%,6/222)。78.8%(175/222)病例通过男男性行为(men who have sex with man,MSM)感染,MSM平均年龄(31.3±10.5)岁。2019—2023年URFs发现比例从4.0%(34/843)增加到7.4%(60/807)。在1.5%最适基因距离阈值下构建分子网络,入网率49.5%(110/222),鉴别出23个簇;发现1个含有39个病例的同性和异性混合活跃传播大簇,重组型为CRF01_AE/CRF07_BC,平均基因距离0.005。URFs传播性耐药发生率为3.2%(7/222)。结论杭州市新报告HIV-1感染者HIV-1 URFs主要在青壮年MSM中产生和传播,呈逐年递增趋势,存在需要重点关注和有效干预的活跃传播大簇,急需制定有效干预措施防止该簇继续扩张,同时应持续加强监测本市URFs的发生和传播,了解分子簇及耐药动态。Objective To understand the molecular epidemiological characteristics of unique recombinant forms(URFs)in newly reported HIV-1 patients in Hangzhou,and provide theoretical support for prevention and control of AIDS.Methods The blood samples of newly-diagnosed HIV-1 infected cases who received no antiviral therapy from 2019 to 2023 were collected,pol gene was amplified by RT-PCR and nested PCR,followed by sequencing.The URFs were screened using phylogenetic tree,followed by recombinant analysis.Genetic distances between URFs sequences were calculated and molecular transmission networks were constructed.The calibrated population resistance program(CPR)was used to analyze transmissible drug-resistant mutations.Results A total of 222(5.0%,222/4471)URFs pol gene sequence were obtained,and the recombination types were CRF01_AE/CRF07_BC(60.4%,134/222),CRF01_AE/C(11.7%,26/222),CRF01_AE/B(9.5%,21/222),CRF01_AE/B/C(8.1%,18/222),B/C(7.6%,17/222)and CRF55_01B/CRF07_BC(2.7%,6/222),respectively.78.8%(175/222)were infected by men who have sex with man(MSM),whoes mean age was 31.3±10.5.The proportion of URFs increased from 4.0%(34/843)to 7.4%(60/807)from 2019 to 2023.Under the optimal gene distance threshold of 1.5%,the molecular network access rate was 49.5%(110/222),included 23 clusters.We found a large active transmission cluster with 39 cases mixed homosexual and heterosexual,the recombination types was CRF01_AE/CRF07_BC,and the average gene distance was 0.005.Prevalence of URFs transmissible resistance was 3.2%(7/222).Conclusions URFs are mainly produced and transmitted in young MSM,which shows an increasing trend year by year.There is a large active transmission cluster required major attention and effective intervention to prevent further expansion.At the same time,the occurrence and transmission of URFs should be continuously monitored to understand the clusters and drug resistance dynamics.

关 键 词：人类免疫缺陷病毒 独特重组型 监测性耐药突变 分子网络 

分 类 号：R512.91[医药卫生—内科学] R181.3[医药卫生—临床医学]