我国男男性行为人群HIV-1新发感染者亚型及原发耐药分析

HIV-1 subtypes and primary drug resistance among recently infected men who have sex with men in China

目的为了掌握全国男男性行为人群（MSM人群）HIV原发耐药状况，本研究在BED—EIA新发感染筛查阳性者中开展了亚型及耐药性检测。方法采用同伴推动抽样（简称RDS）或分类滚雪球抽样方法在13个省份男男性行为人群中开展抽样调查，确证阳性者进行BED—EIA检测。通过PCR反应和基因测序对214个新发感染样本进行HIV—1亚型及原发耐药分析。结果扩增成功104个样本，CRF01-AE、CRF07-BC和B’亚型分别占62．5％、28．8％和8．7％；耐药突变发生率20．2％，潜在耐药13个、低度耐药6个，中度耐药4个、高度耐药2个；逆转录酶区耐药突变发生率较高；蛋白酶抑制剂、核苷类反转录酶抑制剂、非核苷类反转录酶抑制剂相关耐药突变发生率分别为7．69％、6．73％及10．6％；耐药发生率14．4％。结论我国MSMHIV新发感染人群中原发耐药问题不容忽视，有必要对MSM人群开展治疗前耐药检测；另外，还需加大感染者管理、加强干预力度，以应对我国MSM人群未来可能的艾滋病治疗原发耐药的严峻考验。

Objective To investigate HIV primary drug resistance among men who have sex with men （MSM） in China, subtyping and primary drug resistance analysis were carried out with BED-EIA positive samples. Methods Subjects were recruited in 13 provinces. Samples confirmed to be antibody positive were tested by BED-EIA and then subtypes and primary drug resistance analysis of 214 recently infected samples were performed by PCR and sequencing. Results Subtypes of CRF01_AE, CRF07_BC and B＇ accounted for 62. 5% ,28.8% and 8.7% of 104 samples amplified. Drug resistance mutations were identified in 20. 2% patients. Potential resistance, low-level resistance, intermediate resistance and high-level resistance were respectively found in 13,6, 4 and 2 individuals. Drug resistance mutation in reverse transcriptase region occurred most frequently. Protease inhibitor, nucleoside analog reverse transcriptase inhibitor and non-nucleoside analog reverse transcriptase inhibitor related mutation were respectively identified in 7.69% , 6. 73% and 10. 6% samples. Drug resistance prevalence was 14. 4%. Conclusions Drug resistance amongrecently HIV-infected MSM merits adequate attention and baseline drug resistance testing before antiretroviral therapy initiation for gay men is necessary. In addition, intensified management of infected patients, strengthened intervention efforts were needed for response to the possible severe challenge by primary drug resistance prevalence among Chinese MSM population in the future.