四川省某县级市HIV高危传播者危险因素研究

Analysis of characteristics of HIV high-risk spreaders in a county in Sichuan Province

目的了解四川省某县级市新诊断的感染者分子传播网络特征,分析相关传播危险因素,为精准预防提供科学依据。方法采用序贯纳入原则纳入某县级市2019年3月至2021年8月的新诊断HIV感染者。采用巢式PCR扩增法对HIV-1 pol基因区进行扩增,通过比较序列、构建系统发育树和计算成对距离,最终构建分子传播网络。高危传播者的相关影响因素分析采用χ2检验或者Fisher确切概率法,多因素分析采用Logistic回归。结果共获得有效序列461份,检测出6种毒株亚型,分别为CRF01_AE(51.41%)、CRF07_BC(34.06%)、B(9.76%)、CRF08_BC(3.25%)、CRF55_01B(1.08%)和C(0.43%)。基因距离在0.009时的成簇数最高,245条序列入网,形成54个传播簇,入网率为53.15%。多因素分析显示:≥50岁比18~49岁成为高危传播者的概率高(OR=2.042,P=0.026);职业中其他/不详(OR=0.360,P=0.014)低于农民,CRF07_BC亚型(OR=0.170,P<0.01)、CRF08_BC(OR=0.068,P=0.011)低于CRF01_AE亚型,B亚型(OR=4.131,P=0.001)高于CRF01_AE亚型。结论调查地区HIV感染来源多元化,应重点加强B亚型、≥50岁老年人群以及农民的长期与动态监测,采取有效干预,防止感染。

Objective To understand the molecular transmission network characteristics of newly diagnosed infections in a county of Sichuan Province,analyze the risk factors of transmission and provide scientific basis for accurate prevention.Methods The new HIV-infected patients in a county from March 2019 to August 2021 were enrolled by sequential inclusion principle.The HIV-1 pol gene region was amplified by nested PCR.The molecular transmission network was constructed by comparing sequences,constructing phylogenetic tree and calculating pairwise distance.The related influencing factors of high-risk communicators were analyzed byχ2 test or Fisher's exact probability method,and multivariate analysis was performed by Logistic regression.Results A total of 461 valid sequences were obtained,and 6 strain subtypes detected,namely CRF01_AE(51.41%),CRF07_BC(34.06%),B(9.76%),CRF08_BC(3.25%),CRF55_01B(1.08%)and C(0.43%).When the gene distance is 0.009,the number of clusters is the highest,and 245 sequences enter the network,forming 54 propagation clusters,with the network entry rate of 53.15%.The risk of high-risk communicators of age≥50 years is higher than that of 18 to 49 years old(OR=2.042,P=0.026),other/unknown in occupation(OR=0.360,P=0.014)is lower than that of farmers,and CRF07_BC subtype(OR=0.170,P<0.01)and CRF08_BC(OR=0.068,P=0.011)of the strain subtypes are less dangerous than CRF01_AE subtype,and the risk of subtype B(OR=4.131,P=0.001)was higher than that of CRF01_AE subtype.Conclusions The sources of HIV infection in the investigated areas are diversified.The long-term and dynamic monitoring among subtype B,the elderly population aged≥50 and farmers should be strengthened.Effective interventions should be taken to prevent infection.