新疆静脉吸毒者HIV-1原发耐药分析

Primary HIV-1 drug resistance among injecting drug users in Xinjiang

目的研究新疆伊犁州经静脉吸毒(IDU)感染人类免疫缺陷病毒1型(HIV-1)未经抗病毒治疗者原发耐药株的流行情况。方法于2009年12月—2010年3月收集新疆伊犁州77例IDU HIV-1感染者血样及流行病学信息,提取血浆病毒RNA,逆转录聚合酶链反应(RT-PCR)和巢式PCR方法扩增pol基因区1.3 kb片段并测序;构建系统进化树分析病毒亚型,提交斯坦福大学HIV耐药数据库进行耐药性分析。结果 77例感染者中,76例(98.7%)为CRF07_BC亚型,1例(1.3%)为B亚型;蛋白酶区未检出主要耐药突变,耐药相关次要突变主要出现在第10、58和71位;其中71位氨基酸突变发生频率最高(11/77),其次为第10位(6/77)和第58位(3/77);第71位氨基酸由野生型的A突变为V者7例,突变为T者3例,突变为I者1例;第10位氨基酸由野生型的L突变为I者5例,突变为V者1例;第58位氨基酸由野生型的Q突变为E者3例;1例病例逆转录酶区同时存在Y181C及M184V耐药突变。结论新疆伊犁州未接受抗病毒治疗的IDU感染者中检出原发耐药株,原发耐药率处于较低水平,但应加强该地区IDU感染者的耐药监测,防止耐药株产生和流行。

Objective To investigate the prevalence of drug resistance mutations among antiretroviral treatment naive human immunodeficiency virus type 1（HIV-1） infected individuals who got HIV through injecting drug use in Yili state of Xinjiang Uygur Autonomous Region.Methods Whole blood samples and epidemiologic information were collected from 77 HIV-1 infected injecting drug users in Yili state.Viral RNA was extracted from plasma;the 1.3kb pol gene was amplified by reverse transcriptase-PCR（RT-PCR） and nested PCR.The purified amplification products were sequenced directly.Subtypes of HIV-1 were determined through phylogenitic analysis.Drug resistant genotypes were analyzed with Stanford HIV Drug Resistance Algorithm.Results Among the 77 HIV-1 infected cases,CRF07_BC strains were predominant（76/77,98.7%） and the subtype B HIV-1 strain was detected in one of the subjects（1.3%）.No major drug resistance mutation was detected in protease coding region.But many minor drug resistance mutations were detected,mainly at position 71（11/77）,10（6/77） and 58（3/77） in protease coding region.In reverse transcriptase coding region,drug resistance mutations at position 181 and 184 were detected at the same time in one subject.Conclusion Drug resistant strain transmission was detected among antiretroviral treatment naive HIV-1 infected injecting drug users in Yili state of Xinjiang,but the prevalence of primary drug resistance was still low.Drug resistance monitoring in injecting drug users should be strengthened to prevent the occurrence the transmission of drug resistant strains.