上海市虹口区2016年新报告HIV-1感染者基因亚型和耐药监测情况

HIV-1 subtypes and pre-treatment drug resistance in newly reported HIV-1-infected cases in Hongkou District,Shanghai in 2016

【目的】了解上海市虹口区新报告人类免疫缺陷病毒(HIV)⁃1感染者的基因亚型分布和抗病毒治疗前的耐药水平,为调整抗病毒治疗方案提供理论参考依据。【方法】以上海市虹口区2016年新报告119例HIV-1感染者为研究对象,通过核酸抽提获得血浆样本中HIV⁃1核酸,采用In⁃house方法对HIV⁃1核酸进行反转录扩增并获得pol区基因,然后对HIV⁃1 pol区基因测序,最后对病毒基因亚型、抗病毒治疗前耐药情况进行分析。【结果】共获得89例HIV⁃1 pol区基因片段,HIV⁃1病毒基因亚型分布为CRF07_BC占38.20%,CRF01_AE占35.96%,B亚型占13.48%,CRF08_BC占7.87%,CRF55_01B和URF0107重组亚型各占2.25%;有13例样本存在耐药相关基因突变,其中对蛋白酶抑制剂(PIs)耐药相关基因突变有3例,对非核苷酸类逆转录酶抑制剂(NNRTIs)耐药相关基因突变有9例,对核苷酸类逆转录酶抑制剂(NRTIs)耐药相关基因突变有1例。治疗前耐药有7例(7.87%,7/89),其中2例高度耐药、1例中度耐药和4例低度耐药;有2例(2.25%,2/89)高度耐药属于治疗前耐药监测列表和传播耐药标准,突变位点分别位于M184V(NRTIs)和K103N(NNRTIs),对依非韦伦、奈韦拉平、恩曲他滨和拉米夫定预测为高度耐药。【结论】应加强HIV⁃1基因亚型监测和耐药监测,重点关注独特重组基因亚型和治疗前耐药基因突变,尤其是URF0107重组亚型以及与依非韦伦、奈韦拉平、恩曲他滨和拉米夫定药物相关的传播耐药突变。

[Objective]To determine the HIV-1 subtypes and pre-treatment drug resistance(PDR)mutations in newly reported HIV-1-infected cases in Hongkou District of Shanghai,and provide evidence for the adjustment of antiretroviral therapy(ART).[Methods]A total of 119 plasma samples of newly reported HIV-1-infected cases were collected in Hongkou District,Shanghai.Nucleic acid extraction was conducted to obtain HIV-1 RNA,and an in-house method was performed to amplify the pol gene fragment using reverse transcription PCR.The pol gene was then sequenced.Subtypes and PDR mutations were determined using HIV BLAST and HIV drug resistance online databases.[Results]A total of 89 HIV-1 pol gene fragments were obtained.Among them,CRF07_BC,CRF01_AE,B subtypes,CRF08_BC,CRF55_01B,and URF0107 accounted for 38.20%,35.96%,13.48%,7.87%,2.25%,and 2.25%,respectively.There were 13 samples with drug resistance mutations,of which 3 mutations were related to protease inhibitors(PIs),9 mutations were related to non-nucleoside reverse transcriptase inhibitors(NNRTIs),and 1 mutation was related to nucleoside reverse transcriptase inhibitors(NRTIs).Furthermore,7(7.87%,7/89)PDR mutations were identified,of which 2 were highly resistant,1 was intermediately resistant and 4 were lowly resistant.Additionally,2(2.25%,2/89)PDR mutations belonged to the surveillance drug resistance mutations(SDRMs)list and surveillance of transmitted drug resistant(STDR),with mutation sites being M184V and K103N,respectively,which were predicted to be highly resistant to efavirenz,nevirapine,emtricitabine,and lamivudine.[Conclusion]Surveillance on HIV-1 subtype and drug resistance should be strengthened,to focus on certain recombinant subtypes and PDR mutations,especially the URF0107 recombinant subtype and the transmitted drug resistance mutations related to efavirenz,nevirapine,emtricitabine,and lamivudine.