河南省302例新确证HIV感染者和艾滋病患者中HIV毒株基因亚型分布和原发耐药研究

Diversity of HIV-1 subtypes and primary HIV-1 drug resistance among 302 newly confirmed HIV infections/AIDS in Henan province, China

目的 分析河南省新确证HIV感染者和艾滋病患者中新发感染者HIV毒株的基因亚型分布和原发耐药情况。方法 纳入2013年1—6月和2014年1—6月新确证并上报于河南省6个地级市（南阳、漯河、平顶山、商丘、许昌和郑州）的市级和县级CDC的HIV感染者和艾滋病患者为研究对象，收集其阳性报告时报卡信息和随访信息（人口学信息、感染途径和抗病毒治疗情况等）。采集研究对象的血液样本再进行确证试验，共402例，排除11例未能采集到足够血样或溶血、89例未能扩增出或扩增结果不完整的研究对象，最终获取302例完整病例结果纳入最终研究。使用BED捕获酶联法判定研究对象新发和既往感染病例，使用in-house方法进行基因亚型和耐药性的检测。结果 302例研究对象的年龄为（44.0±15.5）岁，其中2013和2014年分别为160例（53.0%）和142例（47.0%），新发感染者占29.5%（89例），其中01_AE、07_BC、B、01_B和其他亚型的新发感染比例分别为31.3%（20/64）、40.5%（30/74）、21.3%（32/150）、3/8和4/6（χ2=13.48，P=0.009）。既往感染者中B亚型所占比例为55.4%（118/213），高于新发感染者[36%（32/89）]（χ2=9.49，P=0.002），而07_BC和其他亚型的构成比[20.7%（44/213）和1%（2/213）]均低于新发感染者[33.7%（30/89）和5%（4/89）]（χ2值分别为5.78、4.08，P值分别为0.016、0.044）。302例研究对象的原发耐药率为6.0%（18例），核苷类逆转录酶抑制剂（NRTI）的耐药率为2.7%（8例），非核苷类逆转录酶抑制剂（NNRTI）的耐药率为3.6%（11例）；B和07_BC亚型的原发耐药率均较高，分别为8.7%（13例）和5.4%（4例）。结论 河南省新确证上报的HIV感染者和艾滋病患者中的HIV毒株亚型中出现一定比例的非B亚型；B亚型的原发耐药率较高，应及时开展HIV的分子流行病学调查并定期开展原发耐药的监测。

Objective To investigate HIV-1 subtype diversity and the frequency of primary drug resistance in newly confirmed HIV infections/AIDS, and the ratio of recently infected cases in Henan.Methods Newly confirmed HIV infections/AIDS from June 2013 to October 2013 and from June 2014 to October 2014 in the municipal CDC and county CDC of six cities in Henan province （Nanyang, Luohe, Pingdingshan, Shangqiu, Xuchang and Zhengzhou） were included in this study. Information on demographics, route of infection and antiviral therapy regimen were obtained from report cards, and at follow-up visits. After collection of blood samples from 402 individuals for confirmatory diagnostic tests, 100 were excluded because of hemolysis or insufficient samples in 11 cases, and incomplete amplification results in 89 cases. Recent HIV infection was determined by the BED capture immunoassay. An in-house method were used for genotypic drug resistance tests and sequence analysis.Results Among the 302 individuals included, the mean age was （44.0±15.5） years, and 160 （53.0%） and 142 （47.0%） cases were confirmed in 2013 and 2014, respectively. The ratio of recent infections was 29.5% （89 cases）, inside, the ratio of recent infections were 31.3% （20/64）, 40.5% （30/74）, 21.3% （32/150）, 3/8 and 4/6 in 01_AE, 07_BC, B, 01_B and other subtypes （B/C, C, 01_BC and 08_BC） （χ2=13.48, P=0.009）. The frequency of the B subtype was higher in former infections, at 55.4% （118/213）, than in recent infections, at 36% （32/89） （χ2=9.49, P=0.002）. In contrast, the ratios of both 07_BC and other subtypes were lower in former infections （20.7% （44/213） and 1% （2/213）, respectively） than recent infections （33.7% （30/89）, χ2=5.78, P=0.016 and 5% （4/89）, χ2=4.08; P=0.044, respectively）. The frequency of primary HIV-1 drug resistance was 6.0% （18 cases） in 302 subjects. The frequency of resistance to nucleoside reverse transcriptase inhibitor （NRTI） and non-nucleoside reverse transcriptase inhibitor （NNRTI） drugs was 2.7% （8 cases） and 3.6% （11 cases）, respectively. Primary HIV-1 drug resistance was more frequent in subtypes B and 07_BC, at 8.7% （13 cases） and 5.4% （4 cases）, respectively.Conclusion Newly confirmed HIV infections/AIDS in Henan province harbored certain proportion of none-B subtypes, the frequency of primary resistance tended to be high in HIV-1B infection. The molecular epidemiology of HIV and the development of primary drug resistance should be regularly monitored.