丽水市HIV-1感染者病毒基因型及耐药基因突变研究

Analysis of genotype and drug resistance of Lishui patients infected with HIV-1

目的了解丽水市人类免疫缺陷病毒Ⅰ型(human immunodeficiency virus-1,HIV-1)感染人群病毒基因型及耐药情况。方法收集未经抗病毒药物治疗的307例新报告病例血浆及经过药物治疗的79例既往感染者血浆,提取核酸检测病毒载量,同时巢式PCR扩增病毒pol区基因片段,对扩增成功样本进行测序、拼接并提交至耐药数据库进行基因型耐药分析。结果 269例基因扩增成功,CRF01_AE型为主要型别,占44.98%。57例存在主要耐药基因突变,28例显示耐药,新报告病例人群耐药率为5.04%(13/258),既往感染人群耐药率为11.39%(9/79)。耐药突变位点为I54IM、K65N、L100I、Y181C、M184V等引起的高度或中度耐药,Q58E、L23I、F77L、G190E等引起低度或潜在耐药。结论丽水市HIV-1耐药传播为中流行(5%~10%)水平,应加强耐药监测。耐药突变位点及耐受药物多样化,应警惕I54M、K70E、M184V、K103N等位点突变引起的FPV、3TC、EFV、NVP耐药。

Objective To investigate the genotype and drug resistance of human immunodeficiency virus typeⅠ（ HIV-1） infection in Lishui. Method 307 cases of newly reported cases of HIV infected people in Lishui from January 2015 to December2016,and 79 patients who had previously been treated with drugs from January 2014 to December 2014 were collected. The nucleic acid was extracted for viral load detection,and then the virus pol region gene fragment was amplified by nested PCR. The successful samples were sequenced,spliced and submitted to the database for genotypic resistance analysis. Results A total of269 cases were successfully amplified. CRF01_AE type was the main type,accounting for 44. 98%. 57 cases were detected with mutations in key genes,and drug resistance was found in 28 cases. The drug resistance rate was 5. 04%（ 13/258） in newly infected individuals,while the rate in past infected people was 11. 39%（ 9/79）. Drug resistance mutation sites were I54 IM,K65N,L100 I,Y181C,M184 V and so on,which caused high or moderate resistance. Q58 E,L23I,F77 L,G190E caused low or potential resistance. Conclusion HIV-1 drug-resistant transmission ratio（ 5-10%） was at the middle level in Lishui,and the surveillance of drug resistance should be strengthened. Resistant mutations and tolerant drugs showed diversification.FPV,3TC,EFV,NVP resistance caused by I54 M,K70E,M184 V,K103N and other site mutations require vigilance.