2020年福建省新报告HIV⁃1感染者分子流行特征

Molecular epidemiological characteristics of newly diagnosed HIV⁃1 cases in Fujian Province in 2020

目的了解2020年福建省新报告HIV⁃1感染者基因亚型及其分布特征,为制定该省艾滋病精准防控策略提供科学依据。方法在2020年福建省新报告且未接受抗病毒治疗的HIV⁃1感染者(不包括艾滋病患者)中,以地级市为抽样单位,按福建省9个地级市前3年报告HIV感染者平均病例数的50%随机抽取调查对象。收集调查对象流行病学个案信息,并采集血样。采用巢氏逆转录PCR法扩增HIV⁃1的pol基因区,对获得序列进行基因型鉴定及系统进化分析。将序列上传至美国斯坦福大学耐药数据库(HIVDB)(http://hivdb.stanford.edu)进行基因型耐药性分析,使用HIVdb Algo⁃rithm 9.4算法进行耐药突变分值计算和药物耐药水平分析。结果共纳入2020年福建省新报告HIV感染者1043例,采集血样测序后成功获得936条序列。该936例HIV⁃1感染者血样中检出9种基因亚型,其中CRF07_BC(52.1%)和CRF01_AE(30.4%)为福建省最主要的流行亚型,其余亚型依次为CRF08_BC(4.9%)、CRF55_01B(3.0%)、C亚型(2.5%)、B亚型(2.1%)、CRF85_BC(1.7%)、CRF59_01B(0.3%)、CRF65_CPX(0.1%),另有26例样本未明确亚型。936例感染者中,检出43例耐药,治疗前耐药率为4.6%;各亚型耐药率由高至低依次为CRF55_01B、CRF08_BC、B、C、CRF01_AE、CRF07_BC及其他,各亚型耐药率间差异有统计学意义(χ^(2)=45.002,P<0.05)。结论2020年福建省HIV⁃1流行基因亚型呈多样性分布,新的重组和耐药毒株不断产生并在不同人群和地区传播流行。建议继续加强HIV⁃1流行毒株亚型监测,及时掌握新型重组毒株及耐药株流行和传播趋势。

Objective To investigate the HIV⁃1 genotype and distribution of newly diagnosed HIV⁃1 cases in Fujian Province in 2020,so as to provide insights into formulation of the precise AIDS control strategy in the province.Methods Newly diag⁃nosed HIV⁃1 cases without antiretroviral therapy(excluding AIDS patients)were randomly sampled from each city of Fujian Prov⁃ince in 2020 at a proportion of 50%of the mean number of HIV⁃infected cases reported across 9 cities of Fujian Province during the past three years.Subjects’demographic and epidemiological data were collected and blood samples were collected.The HIV⁃1 pol gene was amplified using nested reverse⁃transcription PCR assay,and the gene sequences were used for HIV⁃1 genotyping and phylogenetic analysis.The gene sequences were uploaded to the HIV Drug Resistance Database(http://hivdb.stanford.edu)for genotypic drug resistance assays,and the scores and level of HIV drug resistance were estimated using the HIVDB Algorithm version 9.5.Results A total of 1043 newly diagnosed HIV⁃1 cases were reported in Fujian Province in 2020,and 936 gene se⁃quences were successfully obtained following sequencing of blood samples.There were 9 HIV⁃1 genotypes characterized in blood samples from 936 newly diagnosed HIV⁃1 cases,with CRF07_BC(52.1%)and CRF01_AE(30.4%)as predominant subtypes,fol⁃lowed by CRF08_BC(4.9%),CRF55_01B(3.0%),subtype C(2.5%),subtype B(2.1%),CRF85_BC(1.7%),CRF59_01B(0.3%)and CRF65_CPX(0.1%),and unidentified subtypes were found in 26 blood samples.HIV⁃1 drug resistance was detected in 43 out of the 936 newly diagnosed HIV⁃1 cases,with 4.6%prevalence of HIV⁃1 drug resistance prior to therapy,and the highest drug resistance was found in the HIV CRF59_01B subtype,followed by in CRF08_BC,B,C,CRF01_AE,CRF07_BC and other subtypes,with a significant difference in the genotype⁃specific prevalence of HIV⁃1 drug resistance(χ^(2)=45.002,P<0.05).Con⁃clusions There was a HIV⁃1 genotype diversity in Fujian Province in 2020,and emerging recombinant and drug⁃resistant HIV⁃1 strains were detected and spread across patients and regions.Monitoring of HIV⁃1 genotypes is recommended to be reinforced for timely understanding of the transmission and spread of novel recombinant and drug⁃resistant HIV⁃1 strains.