金华市抗病毒治疗失败HIV/AIDS病例HIV-1亚型及耐药分析

HIV-1 subtype and drug resistance in HIV/AIDS patients who failed in antiretroviral therapy in Jinhua City

目的了解浙江省金华市抗病毒治疗失败的艾滋病病毒感染者和艾滋病患者(HIV/AIDS)HIV-1亚型及耐药情况,为完善艾滋病抗病毒治疗策略提供依据。方法收集2023年1月1日—11月30日抗病毒治疗失败(治疗时间>6个月且病毒载量≥1000 copies/mL)的HIV/AIDS病例血浆样本128份,经核酸提取扩增后,采用一代测序法测定HIV-1 pol基因,将序列导入美国斯坦福大学HIV耐药数据库,分析HIV-1基因亚型、耐药突变及耐药情况。结果成功获取118例HIV/AIDS病例的序列,男性94例,女性24例,男女比为3.9∶1;年龄40~<60岁53例,占44.92%;主要经异性性接触感染,92例占77.97%。HIV-1亚型以CRF07_BC和CRF01_AE亚型为主,分别45例和39例,占38.14%和33.05%。75例发现耐药位点突变,突变率为63.56%;突变位点以M184和K103为主,突变率分别为29.66%和28.81%。对≥1种药物耐药58例,耐药率为49.15%;对非核苷酸类反转录酶抑制剂(NNRTI)、核苷酸类反转录酶抑制剂(NRTI)和蛋白酶类抑制剂(PI)的耐药率分别为50.00%、33.90%和4.24%。结论金华市抗病毒治疗失败HIV/AIDS病例HIV-1基因亚型主要为CRF07_BC和CRF01_AE,主要对NNRTI和NRTI耐药。

Objective To investigate HIV-1 subtypes and drug resistance in HIV/AIDS patients who failed in antiretroviral therapy in Jinhua City,Zhejiang Province,so as to provide the basis for improving antiretroviral therapy strategy.Methods Totally 128 plasma samples of HIV/AIDS patients who failed in antiretroviral therapy(treatment for more than 6 months and viral load≥1000 copies/mL)from January 1 to November 30,2023 were collected.After nucleic acid extraction and amplification,the sequences of HIV-1 pol genes were determined using first generation sequencing method,then submitted to HIV resistance database of Stanford University in the United States,and the subtypes,drug resistance mutations and drug resistance status of HIV-1 were analyzed.Results A total of 118 sequences of HIV/AIDS patients were obtained,including 94 males and 24 females(male to female ratio,3.9︰1).There were 53 cases aged between 40 to 59 years,accounting for 44.92%.The main infection routes was heterosexual contact,with 92 cases accounting for 77.97%.The main HIV-1 gene subtypes were CRF07_BC and CRF01_AE,with 45 and 39 cases accounting for 38.14%and 33.05%,respectively.There were 75 cases found to have drug-resistant site mutations,with a mutation rate of 63.56%.The most common mutation sites were M184 and K103,with mutation rates of 29.66%and 28.81%,respectively.There were 58 cases with resistance to more than one drug,with a rate of 49.15%.The rates of resistance to non-nucleoside reverse transcriptase inhibitors(NNRTI),nucleotide reverse transcriptase inhibitors(NRTI)and protease inhibitors(PI)were 50.00%,33.90%and 4.24%,respectively.Conclusion The HIV-1 gene subtypes of HIV/AIDS patients who failed in antiretroviral therapy in Jinhua City are mainly CRF07_BC and CRF01_AE,which are mainly resistant to NNRTI and NRTI.