福建省MSM哨点监测HIV新近感染影响因素及分子流行特征研究

Molecular characteristics and factors influencing recent HIV infections among men who have sex with men at sentinel sites in Fujian Province

目的了解福建省MSM人群HIV新近感染状况,探讨其分子流行特征和相关影响因素,为制定艾滋病防治策略提供科学依据。方法对福建省2019年MSM哨点监测人群HIV抗体阳性样本采用HIV-1限制性抗原亲和力酶联免疫法(简称LAg-Avidity EIA)进行新近感染检测,用多因素Logistic回归分析其影响因素,通过RT-PCR扩增pol和gag区,利用系统进化树和HIV db Program软件对序列进行基因亚型和耐药突变分析。结果福建省2019年哨点监测MSM人群863人,其中总的HIV抗体阳性率为12.17%(105/863),HIV新近感染率为11.97%;Logistic回归分析显示,样本来源和最近6个月内同性肛交安全套使用频率是新近感染的影响因素;基因亚型以CRF07_BC(47.61%)和CRF01_AE(38.10%)为主,其次为CRF55-01B(9.52%)、B亚型(4.76%);HIV-1耐药率为6.67%(1/15),其中15例对蛋白酶类抑制剂、核苷类逆转录抑制剂均敏感;1例对非核苷类逆转录酶抑制剂efavirenz(EFV)和nevirapine(NVP)产生高度耐药,1例为潜在耐药。结论福建省2019年哨点监测MSM人群HIV新近感染率处于较高水平,多种亚型并存,发现原发耐药株传播,应加强对HIV新近感染者的分子流行特征变化趋势以及原发耐药传播的动态监测,及时调整防控策略,有效控制福建省艾滋病感染与传播。

This study investigated the prevalence,molecular characteristics and factors influencing recent HIV infections among men who have sex with men(MSM)in Fujian Province,to provide insights into the development of HIV/AIDS control strategies.Recent HIV infections were detected in MSM positive for anti-HIV with HIV-1 LAg-Avidity enzyme immunoassays at sentinel sites in Fujian Province in 2019.The factors affecting recent HIV infections among MSM were identified with multivariate logistic regression analysis.In addition,the segments of the pol and gag gene regions of HIV were amplified with real-time PCR,and the gene subtypes and drug resistance mutations were assessed with phylogenetic analysis and HIV DB software.The overall prevalence rates of anti-HIV antibody and recent HIV infections were 12.17%and 11.97%among 863 MSM at sentinel sites in Fujian Province,2019.Multivariate logistic regression analysis identified the sources of samples and the frequency of condom use during homosexual anal sex in the prior 6 months as factors affecting recent HIV infections.CRF07_BC(47.61%)and CRF01_AE(38.10%)were the most predominant HIV-1 strains,followed by CRF55-01B(9.52%)and subtype B(4.76%).The proportion of HIV-1 drug resistance was 6.67%(1/15);15 cases were sensitive to both protease inhibitors and nucleoside reverse transcription inhibitors;one case presented high-level resistance to the non-nucleoside reverse transcriptase inhibitors efavirenz and nevirapine;and one case was potentially resistant.The prevalence of recent HIV infections was high among MSM at sentinel sites in Fujian Province in 2019;multiple subtypes were identified;and spreading of primary drug-resistant HIV strains was observed.Dynamic monitoring of changes in the molecular characteristics and spread of primary drug-resistant HIV strains should be intensified among MSM with recent HIV infections,and timely adjustment of the HIV/AIDS control strategy will be required to effectively contain HIV/AIDS infection and spread in Fujian Province.