中国南方3省173例HIV/MTB双重感染病例分子流行特征研究

Study on molecular characteristics of 173 HIV/MTB co-infection patients from three provinces in southern China

目的开展人类免疫缺陷病毒/人结核分枝杆菌（HIV/MTB）双重感染病例分子分型及变异重组和流行特征研究,分析其传染源、变异性及其在人群中的传播特点和地区分布特征,为HIV/MTB双重感染病例的管理与临床精准治疗提供理论依据。方法对2014—2015年采集到的江西、广东、云南3省部分HIV/MTB双重感染173例患者115份确证的HIV阳性样本和105份鉴定的MTB菌株,分别用巢氏PCR方法和24位点MIRU-VNTR基因分型方法进行基因分型。结果流行病学个案调查资料结果显示,HIV/MTB双重感染病例以男性为主,年龄以中青年（18～59岁）为主,职业以农民、无业、务工/商人为主,传播途径以性传播和肺部感染为主,其感染顺序为先感染HIV后感染MTB占95%。分子分型结果显示,HIV/MTB双重感染病例样本中115份HIV阳性样本成功扩增分型85份,共发现8种HIV亚型/重组型;HIV/MTB双重感染病例中105份MTB样本成功扩增分型100份,结核分枝杆菌分为5个基因群（Ⅰ群、Ⅱ群、Ⅲ群、Ⅳ群、Ⅴ群）,共95个基因型。结论我国南方3省HIV/MTB双重感染病例中HIV主要流行亚型为CRF01_AE和CRF07_BC重组型;MTB主要流行株以I群和Ⅱ群为主,与单纯感染HIV和单纯感染MTB的流行株类型一致。HIV与MTB主要流行亚型之间是否存在相互易感还有待于进一步研究。

Objective To surveillance the molecular genotypes and epidemiological characteristics of HIV and MTB of HIV/MTB co-infection patients,analyze the genetic variability,transmission characteristics and regional distributions,and to provide a scientific basis for management and accurate treatment of the HIV/MTB populations. Methods 173 HIV/MTB cases,including 115 HIV positive samples and 105 MTB samples from Jiangxi,Guangdong,Yunnan province,were applied for genotyping by nested-PCR and 24-locus MIRU-VNTR,2014-2015. Results Epidemiological surveys showed that in HIV/MTB populations studied,men,young and middle-ages′（18-59） farmers,unemployed people and workers occupied the most;the prevalent transmission were sex and pulmonary infection. 95% were first infected with HIV. Molecular epidemiology study showed that 85 out of 115 HIV samples could be amplified successfully,with 8 different subtypes had been identified. For MTB,100 out of 105 samples could be amplified,with five groups（Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ）,95 genotypes.Conclusion The dominant HIV subtypes were CRF01_AE and CRF07_BC,and the dominant MTB genotypes were I andⅡin HIV/MTB populations,which were consistent with the HIV or MTB mono-infected populations. It is still need to study the interaction between the dominant subtypes of HIV and MTB.