2021年苏州市新报告HIV-1感染者抗病毒治疗前耐药及亚型分析

Analysis of drug resistance and subtypes of newly reported HIV-1 individuals prior to antiretroviral therapy in Suzhou City in 2021

目的了解苏州市新报告HIV-1感染者抗病毒治疗前耐药以及耐药位点突变情况。方法选取苏州市2021年新报告的HIV-1感染者780例,治疗前采集全血样本,提取血浆中的HIV-1病毒RNA,经反转录、巢式PCR扩增HIV-1 pol区基因后,进行sanger测序和基因型鉴定,并上传至斯坦福耐药数据库进行耐药分析。结果780例样本中成功扩增691例,基因型以CRF07_BC(占38.4%)及CRF01_AE亚型(占35.6%)为主,发生不同程度耐药突变53例,治疗前总耐药率为7.7%,对核苷类逆转录酶抑制剂(NRTIs)、非核苷类逆转录酶抑制剂(NNRTIs)、蛋白酶抑制剂(PIs)耐药率分别为0.4%、5.1%、2.7%。不同婚姻状况(χ^(2)=10.55,P<0.05)、不同HIV-1亚型(Fisher's精确检验,P<0.05)患者耐药率差异均有统计学意义。691例成功扩增样本中检测到耐药突变位点19种,对PIs、NRTIs、NNRTIs区耐药基因突变占比分别为3.5%、0.7%、18.4%;PIs突变频率最高位点为Q58E(60.0%),NNRTIs为V179D/E/T(64.9%),NRTIs区少数出现M41L、L210W以及T215S等耐药位点突变。结论2021年苏州市新报告HIV-1感染者治疗前耐药率较高,应加强耐药监测,及时调整抗病毒治疗方案,减少耐药病毒株的产生及传播。

Objective To investigate the drug resistance and mutations in drug resistance sites among newly reported HIV-1 individuals prior to antiretroviral therapy in Suzhou City.Methods A total of 780 newly reported HIV-1 patients were sampled from Suzhou City in 2021.Whole blood samples were collected prior to treatment,and HIV-1 viral RNA was extracted from blood plasma.Following reverse transcription,nested PCR amplification of the HIV-1 pol gene,sanger sequencing and genotyping were performed.The gene sequences were uploaded to the Stanford HIV drug resistance database for drug resistance analysis.Results The HIV-1 pol gene was successfully amplified in 691 out of 780 blood samples,and the genotypes mainly included以CRF07_BC(38.4%)and CRF01_AE subtype(35.6%).Mutation in drug resistance was detected in 53 cases,and the overall prevalence of pretreatment drug resistance was 7.7%.The prevalence of resistance to nucleoside reverse transcriptase inhibitors(NRTIs),non-nucleoside reverse transcriptase inhibitors(NNRTIs)and protease inhibitors(PIs)was 0.4%,5.1%and 2.7%,respectively.The prevalence of HIV-1 drug resistance varied marital status(χ^(2)=10.55,P<0.05)and HIV-1 subtype(P<0.05).Among the 691 cases with successful amplification of the HIV-1 pol gene,19 drug-resistant mutation sites were identified,and the proportions of PIs,NRTIs and NNRTIs resistance gene mutations were 3.5%,0.7%and 18.4%,respectively.In addition,the site for the highest PIs mutation frequency was Q58E(60.0%)and the site for the highest NNRTIs mutation frequency was V179D/E/T(64.9%),while M41L,L210W and T215S mutations were detected in a few cases with NRTIs resistance.Conclusions The prevalence of pretreatment drug resistance was high among newly reported HIV-1 individuals in Suzhou City in 2021.Improved monitoring of HIV-1 drug resistance and timely adjustment of antiretroviral therapy regimens are recommended to reduce the emergence and spread of drug-resistant HIV-1 strains.