广州市2008-2015年未接受抗病毒治疗的男男性行为人群艾滋病病毒感染者耐药分析

Prevalence of drug resistance in treatment-naive HIV infected men who have sex with men in Guangzhou, 2008-2015

目的了解广州市未接受抗病毒治疗的MSM人群HIV感染者（MsM感染者）耐药株流行状况。方法收集2008--2015年新确证HIV-1抗体阳性、现住址为广州市、传播途径为男男性行为传播、确证时未接受过抗病毒治疗的MSM感染者血清样本，提取HIV-1RNA，采用巢式PCR法扩增HIV-1pol区全部蛋白酶（PR）和部分反转录酶（RT）基因片段，测序后提交到美国斯坦福大学HIV耐药数据库进行耐药分析。结果2283例MSM感染者中，共有1986例血清样本成功获得pof区基因片段，年龄16～84（30．18±8．24）岁；未婚者占74．17％（1473／1986）；汉族占90．64％（1800／1986）；大专及以上占49．65％（986／1986），高中及中专占27．14％（539／1986），初中及以下占20．89％（415／1986）。HIV-1亚型以CRF07BC和CRF01AE为主，分别为38．22％（759／l986）和34．49％（685／1986）。总耐药率为3．32％（66／1986），对蛋白酶抑制剂（PIs）耐药率为1．36％（27／1986）），对核苷类反转录酶抑制剂（NRTIs）耐药率为0．65％（13／1986），对非核苷类反转录酶抑制剂（NNRTIs）耐药率为1．61％（32／1986）。B亚型对3类药物的耐药率均较高，CRF5501B对NNRTIs耐药率高于其他亚型。B亚型对司他夫定（D4T）、依非韦仑（EFV）、奈韦拉平（NvP）的耐药率最高，均为4．17％（5／120）；其次是那非那韦（NFV）、齐多夫定（AZT）、利匹韦林（RPv），均为3．33％（4／120）。CRF5501B对EFV、NVP的耐药率最高，均为5．50％（16／291）；其次是依曲韦林（ETR）、RPV，均为5．15％（15／291）。结论广州市未接受抗病毒治疗的MSM感染者耐药率处于低水平，现有抗病毒药物在总体上仍是有效的。但B亚型和CRF5501B亚型耐药率相对较高，值得关注。

Objective To understand the prevalence of drug resistance in treatment-naive HIV infected men who have sex with （MSM） in Guangzhou. Methods HIV-1 RNA were extracted from the serum specimens of the MSM newly confirmed to be HIV-1 positive, living in Guangzhou and receiving no anti-viral therapy from 2008 to 2015. HIV-1 pol gene segments, including full protease and part reverse transcriptase, were amplified by nested reverse transcription polymerase chain reaction （nested-PCR） and sequenced by Sanger. Subsequently, the sequence data were submitted to Stanford University HIV Drug Resistance Database for drug resistance analysis. Results Among 2 283 HIV infected MSM, HIV-1 pol gene segments were obtained from the serum samples of 1 986 HIV infected MSM aged 16-84 （30.18± 8.24） years. Among them, the unmarried accounted for 74.17% （1 473/1 986）, those of Han ethnic group accounted for 90.64% （1 800/1 986）, those with education level of college or above accounted for 49.65% （986/1 986）, those with education level of senior high school or secondary school accounted for 27.14% （539/1 986）, those with education level of junior high school or below accounted for 20.89% （415/1 986）. The distribution of subtypes was predominated by CRF07_BC （38.22%, 759/1 986） and CRF01_AE （34.49%, 685/1 986）. The overall prevalence of drug resistance was 3.32% （66/1 986）. The prevalence of resistance to protease inhibitors （PIs）, nucleoside reverse transcriptase inhibitors （NRTIs） and non-nucleoside reverse transcriptase inhibitors （NNRTIs） were 1.36%（27/1 986）, 0.65% （13/1 986） and 1.61% （32/1 986）, respectively. Subtype B had higher resistance to PIs, NRTIs and NNRTIs and subtype CRF55_01B had highest resistance to NNRTIs compared with other subtypes. In subtype B, the resistant rates to D4T, EFV and NVP were highest （all 4.17%, 5/120）, followed by those to NFV, AZT and RPV （all 3.33%, 4/120）. In subtype CRF55_01B, the resistant rates to EFV and NVP were highest （all 5.50%, 16/291）, followed by those to ETR and RPV （all 5.15%, 15/291）. Conclusions The prevalence of drug resistance in treatment-naive HIV infected MSM in Guangzhou remained at low level and current antiretroviral drugs are generally effective. However, subtype B and CRF55_01B have higher drug resistance.