北京市某医院HIV感染者治疗前蛋白酶抑制剂耐药分析

Analysis of protease inhibitor resistance in HIV infected patients before treatment in a hospital in Beijing

目的了解北京市某医院艾滋病病毒感染者治疗前蛋白酶抑制剂(PIs)原发性耐药情况,为临床干预和治疗提供参考依据。方法收集2019年194例未接受抗逆转录病毒治疗的HIV-1感染者外周静脉血血浆,提取患者血浆HIV RNA,通过巢式聚合酶链式反应扩增HIV-1的Pol区,进行测序和分析,以了解耐药突变位点以及病毒对PIs耐药程度。结果获得Pol区序列167条,扩增成功率为86.1%(167/189),感染途径以性传播为主,占94.4%(151/167),研究人群的原发性耐药率为8.38%(14/167),PIs耐药占总人数的4.19%(7/167),PIs相关的主要突变位点包括D30N和M46L/I,次要突变位点为Q58E、L10F,出现对NEF的中高度耐药,WHO推荐的3种PIs无耐药情况发生,存在潜在耐药的可能性。结论PIs耐药在该地区出现传播,但处于低度流行状态,当前以PIs为基础的治疗方案可行。我们需要加强对PIs的基因型耐药检测,为更好地开展抗逆转录病毒治疗提供科学依据。

Objective To investigate the primary resistance of protease inhibitors to HIV infection in a hospital in Beijing,and to provide reference for clinical intervention and treatment.Methods Peripheral venous blood plasma was collected from 194 HIV-1 infected patients who had not received antiretroviral therapy in 2019.HIV RNA was extracted and Pol region of HIV-1 was amplified by nested polymerase chain reaction for sequencing and analysis,to understand the drugresistant mutation sites and the degree of virus resistance to PIs.Results Totally 167 Pol region sequences of Pol area were obtained,the amplification success rate reached 86.1%(167/189).The main route of HIV infection was sexual transmission,amounted for 94.4%(151/167),the primary resistance of the study population was 8.38%(14/167),primary resistance to PIs accounted for 4.19%(7/167)of the total population.The main PIs-related mutation sites included D30N and M46L/I,while the secondary mutation sites were Q58E and L10F.Moderate to high resistance to NEF has emerged,and no resistance to the three WHO-recommended PIs has occurred,with the possibility of potential drug resistance.Conclusions PIs resistance has shown signs of transmission in the region,but is in a low prevalence state,and current PIs-based treatment regimens are feasible.We need to strengthen genotype resistance testing of PIs to provide a scientific basis for better antiretroviral treatment.