四川省2014年人类免疫缺陷病毒1型耐药警戒线调查

Drug resistance threshold survey of HIV-1 in Sichuan in 2014

摘要：目的了解四川省开展艾滋病抗病毒治疗后，耐药毒株的传播情况。方法根据世界卫生组织（WHO）推荐的资源最小化人类免疫缺陷病毒（human immunodeficiency virus，HIV）警戒线调查方法（HIV drug resistance threshold survey, HIVDR-TS）,采集符合调查标准（2014年新报告、未进行抗病毒治疗、16～25岁）的HIV-1感染者的血样53份，扩增HIV-1 pol基因区1．3kb片段，进行基因型耐药分析，用MEGA5．0软件构建进化树，分析毒株亚型。结果在53份血样中获得47条有效分析序列，仅1例样本出现针对PR区的次要耐药突变Q58E。病例传播途径以性传播为主，其中同性恋占46．81％（22／47），异性传播占53．19％（25／47）。进化树分析表明，毒株亚型以CRF07-BC为主（82．98oA，39／47），其次为CRF01-AE（12．77％，6／47），CRF02-AG和CRF08-BC亚型各1例。结论CRF07-BC和CRF01-AE是四川省16～25岁人群最主要的HIV-1流行株。四川省HIV耐药株的传播处于低度水平，这也表明，目前四川省一线药物的治疗方案依然有效。但十分有必要在四川省继续开展连续的传播性耐药情况监测。

Objective To survey the prevalence of HIV-1 drug resistance in Sichuan province in 2014. Meth- ods According to the HIV drug resistance threshold survey （HIVDR-TS） recommend by World Health Or- ganization （WHO）, fifty-three plasma samples were collected from people newly-reported infected HIV- 1 who were aged from 16 to 25 years old and randomly selected by binomial sequential sampling. Then, extracted RNA from plasma and the region of pol genes were amplified by RT-PCR and nested PCR. Antiretroviral-re- sistant mutations were determined for analysis by sequencing the region of pol genes, and the analysis of sub- type was conducted by using MEGA4.0 software to construct phylogenetic tree. Results Forty-seven sam- ples sequences were obtained, only one sequence appeared to have a secondary drug resistance mutation （Q58E） in PR region. Sexual transmission was the primary transmission route. Subtype analysis showed that the predominant strains were CRF07 _BC （82.98%, 39 /47）, followed by CRF01 _AE （12.77%, 6 /47）, CRF02 _.A_G and CRF08 _BC subtypes only has each 1 case. Conclusions CRF07 _BC and CRF01 _AE are the most important HIV-1 epidemic strains in Sichuan province. The prevalence of HIV-1 drug resistance in Si- chuan province was estimated as low （〈5 % ）, which shows that the current treatment of first-line drugs in Si- chuan is still effective. But it is necessary to carry out the continuous transmission of drug resistance monitoring in Sichuan province.