2017—2018年湖北省HIV-1抗病毒治疗失败患者耐药检测结果分析

Genotyping analysis of drug resistance related gene mutations in HIV-1 patients who failed in antiviral therapy in Hubei Province,2017-2018

目的分析2017—2018年湖北省一线抗病毒治疗失败艾滋病患者HIV-1耐药基因突变情况,为临床治疗方案提供参考。方法采集湖北省一线抗病毒治疗时间超过12个月,病毒载量>103 copies/mL的HIV患者血浆标本,进行耐药基因型检测,分析耐药发生情况及特点。结果共筛选出198例患者,成功检测并获得182例目的基因序列,基因亚型以CRF01_AE为主,总耐药率达到69.23%,NRTIs,NNRTIs和PIs耐药突变组成比分别为46.15%,65.38%和0.55%,发生NRTIs和NNRTIs交叉耐药突变达到40.66%。NRTIs相关的突变位点主要为M184V和K65R;NNRTIs则为V179D,K103N和Y181C;PIs突变位点仅有一例M46I。结论湖北省HAART失败人群中HIV-1基因型耐药比例高,多重耐药现象频发,需要加强耐药监测,及时调整抗病毒治疗方案,减少耐药毒株的产生和传播。

Objective To analyze HIV-1 drug resistance gene mutations in AIDS patients who failed first-line antiviral therapy in Hubei Province from 2017 to 2018,and to provide references for clinical treatment.Methods Plasma samples of HIV patients who had received first-line antiviral treatment for more than 12 months and had a viral load greater than 103 copies/ml were collected in Hubei Province,and drug resistance genotypes were detected.The prevalence and characteristics of drug resistance were analyzed.Results A total of 198 patients were selected,and 182 target gene sequences were successfully detected.The gene subtypes were mainly CRF01_AE,with a total drug resistance rate of 69.23%.The proportion of NRTIs,NNRTIs and PIs resistance mutations was 46.15%,65.38%and 0.55%,respectively.The occurrence of cross resistance mutations of NRTIs and NNRTIs reached 40.66%.The mutation sites related to NRTIs were mainly M184V and K65R,while the mutation sites related to NNRTIs were mainly V179D,K103N and Y181C.There was only one case of PIs related mutation at the site of M46I.Conclusion HIV-1 genotyping demonstrated a high proportion of drug resistance in the HAART failure population in Hubei Province,and multi-drug resistance occurred frequently.It is necessary to strengthen the monitoring of drug resistance,implement timely adjustments to antiviral treatment programs,and reduce the occurrence and spread of drug-resistant strains.