珠海市HIV-1感染者抗病毒治疗前耐药情况和影响因素分析

Study on drug resistance and influencing factors among HIV-1 infected people before antiretroviral therapy in Zhuhai

目的了解珠海市抗病毒治疗前的HIV-1感染者耐药情况和影响因素,为艾滋病防控工作提供依据。方法以2014-2020年期间珠海市新确证的636例HIV-1感染者为研究对象,采集血浆,扩增pol区基因序列,进行基因定型和耐药突变分析。结果获得484条pol基因序列,通过进化分析发现7种HIV-1基因亚型和2种重组体,优势亚型为CRF07_BC(42.8%)、CRF01_AE(38.4%)和CRF55_01B(11.6%),重组体鉴定为CRF01_AE/B和CRF01_AE/B/C亚型重组体,6例特殊重组体,其中5例CRF01_AE/B亚型重组体病例均为MSM;总HIV-1耐药率为4.1%(20/484),高度耐药4例,其中MSM有3例高度耐药毒株;单因素和多因素Logistic回归分析结果显示,与CRF55_01B基因型相比,CRF07_BC基因型(OR=0.25,95%CI:0.08~0.82;aOR=0.18,95%CI:0.05~0.72)和CRF01_AE基因型(OR=0.29,95%CI:0.09~0.96;aOR=0.19,95%CI:0.05~0.71)耐药风险较低。结论珠海市HIV-1流行基因型主要为CRF07_BC、CRF01_AE和CRF55_01B;在全人群中抗病毒治疗前HIV-1呈低度耐药;在MSM出现独特重组体和高度耐药毒株。

Objective To explore HIV-1 drug resistance and influencing factors among newly diagnosed people before antiretroviral therapy in Zhuhai to provide a basis for the prevention and control of AIDS.Methods A total of 636 people with newly diagnosed HIV-1 were enrolled in Zhuhai during 2014-2020,before initiating antiviral therapy(ART).Plasma samples were collected.HIV-1 pol gene was amplified,and genotype and drug resistance were analyzed.Results A total Of 484 pol gene sequences were obtained.Seven subtypes and two unique recombinant forms(URFs)were identified by the evolutionary analysis,including three dominant subtypes such as CRF07_BC(42.8%),RF01_AE(38.4%),and CRF55_01b(11.6%).CRF01_AE/B and CRF01_AE/B/C URFs were identified.Among the 6 cases with URFs,5 cases with CRF01_AE/B recombinants were MSM.The overall HIV-1 drug resistance rate was 4.1%(20/484).4 cases were high drug resistance,including 3 cases from MSM.Logistic analysis showed that the risk of drug resistance was lower among CRF07_BC(OR=0.25,95%CI:0.08-0.82;aOR=0.18,95%CI:0.05-0.72)and CRF01_AE(OR=0.29,95%CI:0.09-0.96;aOR=0.19,95%CI:0.05-0.71)compared with CRF55_01B.Conclusion The predominant genotypes were CRF07_BC,CRF01_AE,and CRF55_01B.Drug resistance rate was low in the whole population before antiviral therapy.URFs and highly drug-resistant strains were detected in MSM.