广西壮族自治区2020年新报告≥50岁男性HIV感染者的HIV-1基因亚型分布及其与首次CD4+T淋巴细胞的关联

Distribution of HIV-1 genotypes and its association with first CD4+T lymphocytes among HIV-infected men aged 50 and over newly reported in Guangxi in 2020

目的 分析2020年广西壮族自治区(简称广西)新报告50岁及以上男性(简称中老年男性)HIV感染者的HIV-1基因亚型构成特点及不同基因亚型与首次CD4+T淋巴细胞(简称CD4)计数的关联。方法 以市为抽样单位,采用分层随机抽样法选取广西2020年新报告中老年男性HIV感染者为研究对象,对其血浆进行病毒RNA提取、逆转录扩增、测序、HIV-1基因亚型和亚簇判定,使用多因素模型评价CD4计数可能存在统计学关联的影响因素。结果 共纳入分析606例HIV感染者,主要流行毒株有CRF01_AE、CRF07_BC及CRF08_BC三种,其构成比分别为57.6%(349/606)、17.2%(104/606)及22.1%(134/606),其首次CD4中位数分别为145(51, 271)个/μL、212(110, 330)个/μL及178(100, 307)个/μL。CRF01_AE感染者首次CD4值低于CRF07_BC感染者(Z=-3.363,P=0.002),也低于CRF08_BC感染者(Z=-2.983,P=0.009)。二元logistic回归分析模型分析显示,CRF01_AE为广西中老年人群CD4≤200个/μL的独立危险因素(aOR=1.453, 95%CI:1.047~2.017)。结论 CRF01_AE、CRF07_BC和CRF08_BC为广西2020年新报告中老年男性HIV感染者主要毒株,其构成以CRF01_AE为主,CRF01_AE为CD4≤200个/μL的独立危险因素,提示感染CRF01_AE毒株中老年男性的疾病进展较快,对广西艾滋病流行危害较大。

Objective To analyze the compositional characteristics of HIV-1 genotype among HIV-infected men aged 50 and over(referred to as middle-aged and elderly men) newly reported in Guangxi in 2020, and to analyze the association between different genotypes and the CD4+T lymphocyte(referred to as CD4) count at HIV diagnosis. Methods The stratified random sampling method was used to select middle-aged and elderly male HIV-infected patients in 2020 newly reported in 14 cities in Guangxi as the research subjects, and the plasma of infected patients was subjected to viral RNA extraction, reverse transcription amplification, sequencing, HIV-1 genotype and sub-cluster determination. A multivariate model was used to evaluate possible statistically associated influencing factors of CD4 counts. Results A total of 606 HIV-infected patients were included and analyzed, and the main circulating strains were CRF01_AE, CRF07_BC and CRF08_BC, and their proportions were 57.6%(349/606), 17.2%(104/606) and 22.1%(134/606) respectively, and the medians of their first CD4 at diagnosis were 145(51, 271), 212(110, 330) and 178(100, 307) cells/μL, respectively. The first CD4 count at diagnosis of CRF01_AE infected patients was lower than that of CRF07_BC infected patients(Z=-3.363, P=0.002), and lower than that of CRF08_BC infected patients(Z=-2.983, P=0.009). Binary logistic regression model showed that CRF01_AE was an independent risk factor for CD4 ≤200 cells/μL among newly reported middle-aged and elderly men with HIV infection in Guangxi(aOR=1.453, 95% CI: 1.047-2.017). Conclusions CRF01_AE, CRF07_BC and CRF08_BC are the three main circulating strains of HIV infection among middle-aged and elderly males newly reported in Guangxi in 2020, and major in CRF01_AE. CRF01_AE is an independent risk factor for CD4 ≤200 cells/μL, suggesting that the disease progresses rapidly in middle-aged and elderly men with CRF01_AE strain, which is more harmful to the HIV/AIDS epidemic in Guangxi.