我国HIV-1感染者耐药突变的流行性研究

Prevalence of drug resistance mutations among antiretroviral drug-naive HIV-1-infected patients in China

目的 掌握我国大规模用药前耐药突变在我国HIV 1感染者中流行情况的本底资料。方法 在第二次全国HIV流行病调查 2 0 0 2年样本中随机选取 2 0 % ,对于蛋白酶 (PR)基因区全长和逆转录酶 (RT) 2 0～ 2 30氨基酸位点进行PCR扩增、测序并使用HIVdb DrugResistanceAlgorithm软件进行分析 ,检测耐药相关突变。结果 分别得到 16 4份PR基因区样本和 138份RT基因区样本。PR基因区样本中发现 1份 ( 0 6 1% )样本存在蛋白酶抑制剂 (PI)主要相关突变 ,16 3份 ( 99 39% )样本存在PI次要耐药相关突变。RT基因区样本中发现 8份 ( 5 80 % )具有核苷类逆转录酶抑制剂 (NRTI)耐药相关突变 ,2份 ( 1 4 5 % )存在非核苷类逆转录酶抑制剂 (NNRTI)耐药相关突变。结论 我国未用药HIV感染者中耐药相关突变尚处于低流行状态 。

Objective To collect background information on drug-resistant HIV-1 strains in various regions before the start of nation-wide antiretroviral therapy in China. Methods Twenty percent of the 2 000 blood samples from antiretroviral therapy-naive patients collected for the 2nd national HIV molecular epidemiology survey (NHMES) in 2002 were randomly sampled for this study. The entire protease gene and 20-230 amino acids of the reverse transcriptase gene were amplified by PCR from provirus DNA and sequenced. The results were analyzed with HIVdb-Drug Resistance Algorithm and genotypic resistance mutations were determined to particular anti-HIV drugs. Results Totally 164 protease gene sequences and 138 reverse transcriptase gene sequences were obtained from patients; 0.61% of 164 sequences displayed primary resistance mutations in the protease gene, whereas 99.39% carried 1 or more secondary mutations. Genotypic resistance to at least one nucleoside reverse transcriptase inhibitors (NRTI) was present in 5.80%,and resistance to at least one non-nucleoside reverse transcriptase inhibitors (NNRTI) was present in 1.45% of samples. Conclusion The prevalence of genotypic drug resistance is very low in drug-naive HIV infected patients from 21 provinces of China tested in this study. Laboratories participated in the NHMES have organized a network to provide drug resistance monitoring service in the current nation-wide antiviral treatment program in China.