上海市新确诊HIV-1感染者耐药横断面研究  

Cross-sectional study of drug resistance in newly diagnosed HIV-1 infected patients in Shanghai

作　　者：林倩茹 王绪琴[1] 唐雯琪 董原[1] 岳清[1] 何春燕 郁晓磊 刘长河[1] 韩逸清 冯琬清 宁镇[1] 沈鑫[1] 陈昕 林怡[1] Lin Qianru;Wang Xuqin;Tang Wenqi;Dong Yuan;Yue Qing;He Chunyan;Yu Xiaolei;Liu Changhe;Han Yiqing;Feng Wanqing;Ning Zhen;Shen Xin;Chen Xin;Lin Yi(Shanghai Municipal Center for Disease Control and Prevention,Shanghai 200336,China)

机构地区：[1]上海市疾病预防控制中心,上海200336

出　　处：《中华实验和临床病毒学杂志》2025年第1期69-74,共6页Chinese Journal of Experimental and Clinical Virology

基　　金：上海市加强公共卫生体系建设三年行动计划(2023-2025年)重点学科项目(GWVI-11.1-05)。

摘　　要：目的了解上海市新确诊人类免疫缺陷病毒(human immunodeficiency virus,HIV)1型感染者的耐药情况,为临床抗逆转录病毒治疗(antiretroviral therapy,ART)提供参考依据。方法收集2023年4—6月上海市公共卫生临床中心根据纳入和排除标准筛选出的所有196例新确诊HIV-1感染者外周静脉血血浆,提取HIV-1 RNA,采用逆转录-聚合酶链式反应(reverse transcription-polymerase chain reaction,RT-PCR)扩增pol区进行序列测定,对突变位点及ART药物耐药情况进行分析。结果196例新确诊HIV-1感染者血浆中,成功扩增162份pol区基因序列(扩增成功率为82.65%),亚型由CRF07_BC(51.23%)、CRF01_AE(27.78%)、其他(6.79%)、CRF55_01B(5.56%)、B(3.70%)、CRF01_AE/B(3.70%)、CRF08_BC(1.23%)构成。总体传播性耐药率为7.41%,蛋白酶抑制剂(protease inhibitors,PIs)、非核苷类反转录酶抑制剂(non-nucleoside reverse transcriptase inhibitors,NNRTIs)、核苷类反转录酶抑制剂(nucleotide reverse transcriptase inhibitors,NRTIs)、整合酶抑制剂(integrase inhibitors,INSTIs)耐药率分别为3.09%、3.70%、0.00%和0.62%。B(66.67%)和CRF55_01B(88.89%)中出现NNRTIs相关突变位点的比例多于CRF07_BC(13.25%),CRF55_01B(88.89%)中出现NNRTIs相关突变位点的比例多于CRF01_AE(22.22%)和其他亚型(18.18%),差异具有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,CRF01_AE/B出现PIs相关突变位点的可能性是CRF07_BC的21.71倍[比值比(odds ratio,OR)=21.71,95%置信区间(confidence interval,CI):3.36~140.27,P=0.001]。结论上海市新确诊HIV-1感染者中传播性耐药处于中度流行水平,以NNRTIs和PIs相关耐药为主,INSTIs耐药率较低,应考虑在ART方案中使用INSTIs。ObjectiveTo investigate the drug resistance of newly diagnosed HIV-1 infected patients in Shanghai and to provide reference value for clinical antiretroviral therapy(ART).MethodsThe peripheral venous blood plasma of 196 newly diagnosed HIV-1 infected patients screened according to the inclusion and exclusion criteria at the Shanghai Public Health Clinical Center from April to June 2023 was collected,HIV-1 RNA was extracted,the pol region was amplified by reverse transcription-polymerase chain reaction(RT-PCR)for sequencing,the mutation sites and ART drug resistance were analyzed.ResultsThe plasma of 196 newly diagnosed HIV-1 infected patients was amplified successfully in 162 cases(amplification success rate was 82.65%).The subtypes consisted of CRF07_BC(51.23%),CRF01_AE(27.78%),and others(6.79%),CRF55_01B(5.56%),B(3.70%),CRF01_AE/B(3.70%)and CRF08_BC(1.23%).The overall transmitted drug resistance rate was 7.41%,the protease inhibitors(PIs),non-nucleoside/nucleotide reverse transcriptase inhibitors(NNRTIs),nucleoside/nucleotide reverse transcriptase inhibitors(NRTIs),integrase inhibitors(INSTIs)resistance rates were 3.09%,3.70%,0.00%and 0.62%,respectively.The proportion of NNRTIs-related mutation sites in B(66.67%)and CRF55_01B(88.89%)was higher than that in CRF07_BC(13.25%);the proportion of NNRTIs-related mutation sites in CRF55_01B(88.89%)was higher than that in CRF01_AE(22.22%)and other subtypes(18.18%),the difference was statistically significant(all P<0.05).Multivariate logistic regression analysis showed that the probability of PIs-related mutation sites in CRF01_AE/B was 21.71 times that of CRF07_BC[odds ratio(OR)=21.71,95%confidence interval(CI):3.36-140.27,P=0.001].ConclusionsThe transmitted drug resistance among newly diagnosed HIV-1 infected patients in Shanghai is at the moderate epidemic level,mainly NNRTIs and PIs-related drug resistance,and the INSTIs resistance rate is low,the use of INSTIs in ART regimens should be considered.

关 键 词：人类免疫缺陷病毒 传播性耐药 基因型耐药 亚型 整合酶抑制剂 

分 类 号：R51[医药卫生—内科学]