大理白族自治州2018年HIV/AIDS病毒基因型和抗病毒治疗前耐药研究

Virus Genotypes and Drug Resistance among HIV/AIDS Patients before Antiretroviral Therapy in Dali Bai Autonomous Prefecture in 2018

目的了解大理白族自治州(大理州)HIV/AIDS病毒基因型和抗病毒治疗前HIV-1耐药流行情况,为临床上更有效地进行抗病毒药物的应用提供理论基础。方法收集大理州2018年1月至8月初始抗病毒治疗的HIV/AIDS 122例,扩增pol区基因,进行HIV-1基因分型和治疗前耐药水平分析。结果纳入122例HIV/AIDS,成功获得HIV-1 pol区基因序列114条。通过构建系统进化树进行分析,发现7种HIV-1基因型,主要的基因型为CRF08_BC(59.6%,68/114)、CRF07_BC(25.4%,29/114)和CRF01_AE(7.0%,8/114);χ^(2)检验分析结果显示HIV-1的基因型构成在主要传播途径中存在差异,差异具有统计学意义(χ^(2)=25.637,P<0.001),其中CRF08_BC在注射吸毒传播和异性性传播途径中占主导地位,同性性传播中以CRF01_AE为主;携带耐药突变位点的比例为21.9%(25/114),比例较高的突变E138A(9.6%,11/114)和V179D/E(9.6%,11/114)均为辅助耐药突变位点。治疗前总的HIV-1耐药率为1.8%(2/114),其中核苷类反转录酶抑制剂(NRTIs)的耐药率为0.9%(1/114),非核苷类反转录酶抑制剂(NNRTIs)耐药率与之相同。结论大理州初始抗病毒治疗的HIV/AIDS中,存在着多种的HIV-1基因型,治疗前耐药尚处于低度水平,为有效维持公共卫生抗病毒治疗策略,需要加强HIV耐药监测工作,及时掌握耐药基因突变数据,适时选择和调整一线抗病毒治疗方案。

Objective To investigate the prevalence of HIV-1 drug resistance and genotypes in HIV/AIDS patients before antiretroviral therapy in Dali Bai Autonomous Prefecture(Dali),so as to provide a theoretical basis for more effective antiviral drug application in the clinic.Methods A total of 122 adults with HIV/AIDS on initial antiretroviral therapy were recruited in Dali from January to August 2018 before antiretroviral therapy.Amplification of HIV-1 pol genes for drug resistance analysis.Results A total of 114 samples were successfully sequenced and 7 HIV-1 genotypes were identified according to the phylogenetic analysis,including three predominant genotypes such as CRF08_BC(59.6%,68/114)、CRF07_BC(25.4%,29/114)and CRF01_AE(7.0%,8/114).The HIV-1 genotypes showed statistical differences among the main transmission route(χ2=25.637,P<0.001).CRF08_BC were mainly in heterosexual and drug users,and CRF01_AE were mainly in homosexual.Surveillance drug resistance mutations(SDRMs)were 21.9%(25/114).A higher proportion of mutations E138A(9.6%,11/114)and V179D/E(9.6%,11/114)were accessory drug-resistant mutations.HIV-1 drug-resistant rate was 1.8%(2/114),and NRTIs and NNRTIs were 0.9%(1/114)respectively.Conclusion In HIV-1/AIDS patients before antiretroviral therapy in Dali,HIV-1 genotypes are multiple,with a low prevalence rate of HIV-1 drug resistance.To maintain effective public health antiretroviral therapy strategies,it is essential to strengthen the monitoring of HIV-1 drug resistance and master the data,and timely select and adjust the first-line antiretroviral therapy plan.