湖南省HIV-1感染者原发性耐药现况调查

Primary drug resistance in HIV-1 infected individuals in Hunan Province

摘要:

目的 了解湖南省1型人类免疫缺陷病毒（HIV-1）感染者其基因亚型分布和原发性耐药（PDR）情况，为艾滋病防控及抗病毒治疗（ART）提供参考依据。 方法 收集湖南省2021年1月—2022年8月某院HIV门诊新确诊并且未接受ART的HIV-1感染者的人口学及流行病学相关数据，采集患者血清，提取核糖核酸，利用In-house的方法采取2轮聚合酶链式反应进行基因扩增，Sanger法对产物进行测序，分析患者临床资料及HIV-1亚型及耐药情况。 结果 共纳入患者667例，基因型耐药检测失败20例，647例检测成功的新确诊HIV-1感染者纳入研究。53例患者感染的HIV-1株发生PDR，发生率为8.19%，主要集中于男性（88.68%）、未婚（71.70%）、男男性行为（MSM，60.38%）、21~40岁的群体（58.49%），且多为湖南省本地籍居民（98.11%）。共检测出15种HIV-1毒株亚型，主要亚型为CRF_01AE（35.70%）、CRF07_BC（25.19%）、B/C（18.86%）以及CRF55_01B（7.88%）。不同HIV-1亚型患者的PDR发生率比较，差异有统计学意义（χ²=18.62，P=0.017）。蛋白酶抑制剂（PIs）耐药率为0.15%，核苷酸类逆转录酶抑制剂（NRTIs）耐药率为2.78%，非核苷酸类逆转录酶抑制剂（NNRTIs）耐药率为6.65%，整合酶抑制剂（INSTIs）耐药率为0.31%。 结论 湖南省HIV-1毒株亚型分布复杂，PDR发生率已超过世界卫生组织制定的低水平耐药预警线（< 5%），应加大感染预防与控制力度，阻断耐药毒株传播。

Abstract:

Objective To explore the subtype distribution and the primary drug resistance (PDR) among human immunodeficiency virus-1(HIV-1) infected individuals in Hunan Province, and provide reference for the prevention and control as well as antiretroviral therapy (ART) of acquired immunodeficiency syndrome. Methods Demographical and epidemiological data of individuals newly diagnosed with HIV-1 infection and without receiving ART in a hospital's HIV clinic in Hunan Province from January 2021 to August 2022 were collected. Patients' serum was taken, ribonucleic acid was extracted, and two rounds of polymerase chain reaction for gene amplification was performed with the In-house method. PCR product was sequenced with Sanger method for analyzing clinical data, HIV-1 subtypes and drug resistance of patients. Results A total of 667 patients were recruited. 20 patients failed the genotypic drug resistance test, thus 647 newly diagnosed HIV-1 infected patients were studied. 53 HIV-1 infected patients had PDR, with a incidence of 8.19%. These patients were mainly male (88.68%), unmarried (71.70%), men who had sex with men (MSM, 60.38%), 21-40 years old group (58.49%), and local residents of Hunan Province (98.11%). A total of 15 subtypes of HIV-1 were detected, and the main subtype were CRF_01AE(35.70%), CRF07_BC (25.19%), B/C (18.86%) and CRF55_01B(7.88%). The differences of PDR incidence in patients with different HIV-1 subtypes were statistically significant (χ²=18.62, P=0.017). Drug resis-tance rates of protease inhibitors (PIs), nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleotide reverse transcriptase inhibitors (NNRTIs) and integrase inhibitors (INSTIs) were 0.15%, 2.78%, 6.65%, and 0.31%, respectively. Conclusion The distribution of HIV-1 subtype in Hunan Province is complex, and the incidence of PDR has exceeded the low-level drug resistance warning line (< 5%) established by the World Health Organization. It is necessary to strengthen the prevention and control of the infection and block the transmission of drug-resistant virus strains.