济南市2022—2023年新报告男男性行为人群HIV-1感染者分子传播网络特征分析  

Characteristics of HIV molecular transmission network of men who have sex with men among newly reported HIV cases,Jinan,2022-2023

作　　者：黄玉洁 林玉玺 李欣 潘晶[1] 韩秀云[1] 焦海涛[1] 刘岚铮[1] HUANG Yu-jie;LIN Yu-xi;LI Xin;PAN Jing;HAN Xiu-yun;JIAO Hai-tao;LIU Lan-zheng(Jinan Center for Disease Control and Prevention,Jinan,Shandong 250021,China;不详)

机构地区：[1]济南市疾病预防控制中心,山东济南250021 [2]山东大学齐鲁医学院公共卫生学院

出　　处：《现代预防医学》2024年第24期4573-4579,共7页Modern Preventive Medicine

基　　金：2022年济南市卫生健康委员会公共卫生计划专项项目(2022-公-03);2023年济南市卫生健康委员会公共卫生计划专项项目(2023-公-22)。

摘　　要：目的通过构建济南市新报告男男性行为人群(men who have sex with men,MSM)人类免疫缺陷病毒-1型(human immunodeficiency virus type 1,HIV-1)感染者的分子传播网络,分析传播网络特征,以提高干预效果,减少新发感染。方法收集2022—2023年济南市新报告HIV-1 MSM感染者的治疗前样本,采用巢氏PCR方法扩增HIV-1 pol区基因并测序,所得序列构建系统进化树确定亚型,构建分子传播网络并分析入网危险因素,通过美国斯坦福耐药数据库识别并分析耐药突变位点。结果本次研究共获得有效序列207条,共发现15种HIV亚型,以CRF07_BC(76例,36.7%)和CRF01_AE(74例,35.7%)为主,其次为B亚型(21例,10.1%),CRF114_0155(9例,4.3%)和CRF55_01B(8例,3.9%)等。选择1.5%为基因距离阈值时,共42条序列入网,入网率为20.3%,形成15个分子簇。Logistic回归分析显示感染者的年龄、文化程度和CD4细胞数与入网相关。多因素分析结果显示,文化程度为大专及以上、CD4计数>500个/μl更容易入网。207例患者样本中有11例存在耐药突变,治疗前耐药率为5.3%,蛋白酶抑制剂(protease inhibitor,PI)耐药突变2例,核苷类逆转录酶抑制剂(nucleotide reverse transcriptase inhibitor,NRTI)耐药突变6例,非核苷类逆转录酶抑制剂(non-nucleoside reverse transcriptase inhibitor,NNRTI)耐药突变2例,整合酶抑制剂(integrase strand transfer inhibitor,INSTI)耐药突变2例,其中有1例患者同时存在NRTI和NNRTI耐药突变。结论济南市HIV-1 MSM感染者中基因亚型多样,主要为CRF07_BC和CRF01_AE,年轻且文化程度较高的感染者是传播网络中的活跃人群。HIV分子传播网络监测是一项长期持续性工作,应加强对网络中重点人群的溯源,采取更有效的干预措施减少HIV的传播。Objective To explore the characteristics of HIV molecular transmission network of men who have sex with men(MSM)among newly reported HIV cases in Jinan,China.Methods The plasma samples of newly reported HIV-1 MSM in Jinan from 2022 to 2023 were collected.The pol region gene was amplified using nested PCR followed by sequencing.The obtained sequences were used to construct phylogenetic tree and molecular transmission network.The related factors for participants entering a cluster were analyzed.Drug resistance mutations were identified and analyzed using the online software of HIV drug resistance database of Stanford University.Results This study obtained 207 sequences and identified 15 HIV-1 subtypes.The dominant subtypes were CRF07_BC(76/207,36.7%)and CRF01_AE(74/207,35.7%),followed by B subtypes(21/207,10.1%),CRF114_0155(9/207,4.3%),and CRF55_01B(8/207,3.9%).Setting 1.5%as the gene distance threshold,a total of 15 molecular clusters were formed by 42 sequences,with a transmission network entry rate of 20.3%.Multivariate Logistic Analysis results showed that MSM with college or above education level and CD4 count>500 cells/μl were more likely to enter the molecular transmission network.Among the 207 participants,11(5.3%)were detected with drug resistance mutations,including 2 with PI resistance mutations,6 with NRTI resistance mutations,2 with NNRTI resistance mutations,and 2 with INSTI resistance mutations.One participant was detected with both NRTI and NNRTI resistance mutations.Conclusion The gene subtypes of newly reported HIV cases are diverse,mainly were CRF07_BC and CRF01_AE.MSM with younger age and higher education level are active populations in the HIV transmission network.HIV transmission network monitoring is a long-term and continuous work,and it is necessary to strengthen the traceability of key populations in the network and provide more effective intervention strategies to reduce the HIV transmission.

关 键 词：人类免疫缺陷病毒 男男性行为人群 基因亚型 分子网络 耐药突变 

分 类 号：R512.91[医药卫生—内科学]