2019—2020年北京市未治疗HIV-1感染者传播性耐药特征分析

Characteristics of transmitted drug resistance in treatment-naive HIV-1-infected individuals in Beijing city,2019-2020

目的:了解北京市未治疗HIV-1感染者蛋白酶-逆转录酶和整合酶基因型耐药发生水平和特征,为临床诊疗提供数据参考。方法:于2019—2020年募集北京市新确诊或新入组接受抗逆转录病毒治疗HIV-1感染者,进行pol基因片段和整合酶基因扩增和测序。系统进化分析判断病毒亚型,通过HIV耐药数据库比对解析耐药突变和药物耐受程度。结果:在募集到的168例病例中,93.6%通过男男性行为途径感染。最主要流行毒株为CRF01_AE(41.0%)和CRF07_BC(30.3%),独特重组型占16.1%。6个病例携带蛋白酶-逆转录酶监测性耐药突变,传播性耐药发生率为3.7%;1个病例治疗基线携带核苷类逆转录酶抑制剂类K65R突变,同时伴有整合酶基因区主要突变T66I(0.6%),对艾维雷韦高度耐受、对拉替拉韦低度耐受。结论:北京市未治疗HIV-1感染者中HIV-1传播性耐药发生率低,应加强包括整合酶基因在内的基因型耐药监测。

Objective To explore the characteristics of HIV-1 genotypic drug resistance for protease-reverse transcriptase(PR-RT)and integrase(IN)among antiretroviral therapy(ART)-naive individuals in Beijing,and provide evidence for clinical diagnosis and treatment.Methods Newly diagnosed individuals or cases initiating ART were recruited in Beijing covering 2019 to 2020,then pol gene fragments and integrase gene were synchronously amplified and sequenced.Phylogenetic analyses were performed to determine subtypes,and the pol gene and integrase gene sequences were submitted to Stanford University HIV drug resistance database for the interpretation of mutations and drug resistance.Results Among 168 ART-naive individuals,93.6%were infected via men who have sex with men(MSM).The top two subtypes were CRF01_AE(41.0%)and CRF07_BC(30.3%),and unique recombinant forms accounted for 16.1%infections.Six individuals carried surveillance drug resistance mutations in PR-RT,with a prevalence of transmitted drug resistance(TDR)at 3.7%.And one case carried nucleoside reverse transcriptase inhibitor mutation of K65R,accompanied with major integrase mutation of T66I(0.6%),conveying resistance to elvitegravir and raltegravir at high and low levels,respectively.Conclusions The prevalence of transmitted drug resistance was considerably low among ART-naive individuals in Beijing,and the surveillance of genotypic drug resistance should be strengthened,including integrase drug resistance.