德宏傣族景颇族自治州报告的HIV-1新感染者中耐药情况及其影响因素

HIV-1 drug resistance and influencing factors among people living with HIV newly infected in Dehong Dai and Jingpo autonomous prefecture,Yunnan

目的了解云南省德宏傣族景颇族自治州(简称德宏州)新报告的艾滋病病毒(HIV)感染者中新近感染者HIV-1耐药情况及其影响因素,为HIV的预防和治疗提供参考依据。方法采用横断面的方法,对德宏州在2015-2018年期间报告的HIV感染者的首次确证剩余血浆,运用限制性抗原亲和力酶联免疫法(LAg-Avidity EIA)检测发现的新感染者,提取核酸并扩增HIV-1 pol基因片段。将pol基因片段序列提交斯坦福大学的耐药数据库,并根据2014年世界卫生组织耐药监测指南的推荐标准,确定耐药突变位点以及HIV毒株对抗病毒药物的敏感性。结果共有227例成功获得HIV-1 pol基因序列,其中HIV-1毒株C亚型为26.4%(60例),CRF01AE亚型为21.1%(48例),CRF07BC亚型12.3%(28例),CRF08BC亚型6.6%(15例),URF占24.7%(56例),其他占8.8%(20例);HIV-1传播性耐药率为11.5%(26例),包括17例男性,14例农民,16例≤30岁,14例未婚,13例傣族,22例性传播,12例中国籍感染者。非核苷类反转录酶抑制剂(NNRTI)、核苷类反转录酶抑制剂(NRTI)和蛋白酶抑制剂(PI)耐药率分别为19例、12例和1例。HIV-1传播性耐药率中国籍为9.6%,缅甸籍为13.7%,两者之间差异无统计学意义(P=0.334)。有8例携带耐药位点K103N同时针对依非韦伦、奈韦拉平高度耐药。多因素Logistics回归分析结果显示,与C亚型相比,CRF08BC亚型的HIV-1耐药风险更高[调整比值比(aOR)=5.88,95%可信区间(CI):1.16~29.71]。结论德宏州报告HIV感染者中新感染者的HIV-1传播性耐药率较高,应当继续加强德宏州传播性耐药的监测工作。

Objective To explore HIV-1 drug resistance and its influence factors among people living with HIV newly infected in Dehong prefecture,so as to provide reference for HIV prevention and treatment.Methods A cross-sectional survey was conducted among people living with HIV newly infected by limiting antigen avidity enzyme immunoassay(LAg-Avidity EIA)with the first confirmed residual plasma from 2015 to 2018.HIV-1 pol genes were obtained and amplified.The sequences were submitted to Stanford university’s drug resistance database,and HIV-1 drug resistance was determined according to WHO Guidelines on HIV drug resistance surveillance of 2014.Results A total of 227 subjects successfully obtained HIV-1 pol gene sequences,including subtype C(26.4%),CRF01_AE(21.2%),CRF07_BC(12.3%),CRF08_BC(6.6%),URF(24.7%),and other(8.8%)etc.The transmitted drug resistance rate of HIV-1 was 11.5%(26/227),with 65.4%(17)male,53.8%(14)farmers,61.5%(16)under 30 years,53.8%(14)unmarried,50.0%(13)Dai,84.6%(22)sexually transmitted,and 46.2%(12)Chinese.The drug resistance rates of nucleoside reverse transcriptase inhibitors(NNRTI),non-nucleoside reverse transcriptase inhibitors(NNRTI)and protease inhibitors(PI)were 8.4%(19/227),5.3%(12/227)and 0.4%(1/227),respectively.The transmitted drug resistance of HIV-1 of Chinese and Burmese nationality were 9.6%and 13.7%,with no significant difference(P=0.334).Eight subjects carried drug resistance sites K103 N with high resistance to Efavirenz(EFV)and Nevirapine(NVP)at the same time.Multivariate logistic analysis showed that compared with other subtypes,CRF08_BC subtype had a higher risk of HIV-1 resistance(aOR=5.88,95%-CI:1.16-29.71).Conclusion The transmitted drug resistance rate of HIV-1 in newly infected HIV patients in Dehong is high.We should strengthen the surveillance of transmitted drug resistance in Dehong prefecture.