桂林市2019-2023年HIV/AIDS患者抗病毒治疗失败后耐药情况分析

Characteristics of drug resistance in HIV/AIDS patients with antiretroviral treatment failure in Guilin city,2019-2023

目的探究桂林市HIV/AIDS患者在抗病毒治疗(antiretroviral treatment,ART)失败后HIV-1耐药情况。方法采集桂林市2019年1月至2023年12月接受ART时间≥1年且HIV病毒载量≥1000拷贝/ml的患者血浆样本,同时收集其人口学信息,进行HIV-1基因型亚型分析和耐药检测,以确定耐药突变位点及毒株对药物的敏感性。结果共收集ART失败并成功扩增的患者样本766例,其中男性536例(69.97%,536/766),平均年龄为54岁;共检出8种HIV-1亚型,其中以CRF01_AE(80.55%,617/766)、CRF07_BC(11.10%,85/766)和CRF08_BC(6.92%,53/766)为主。耐药分析结果显示,HIV-1耐药率为34.86%(267/766),对核苷类反转录酶抑制剂(nucleoside reverse transcriptase inhibitors,NRTIs)、非核苷类反转录酶抑制剂(non-nucleoside reverse transcriptase inhibitors,NNRTIs)和蛋白酶抑制剂(protease inhibitors,PIs)的耐药均有发生,其中以NRTIs/NNRTIs双重耐药(48.31%,129/267)和NNRTIs耐药(43.07%,115/267)为主。共检测到37个耐药突变位点,14个NRTIs相关的突变位点主要包括M184V/I(47.57%,127/267)、K65R(18.73%,50/267)、K70E/N/T/G/R(13.11%,35/267)等;18个NNRTIs相关的突变位点主要包括K103N/R(56.93%,152/267)、V179D/E/T(21.72%,58/267)、G190C/S/Q(17.23%,46/267)和V106I/M(16.85%,45/267)等;5个PIs相关的突变位点以L10V/I突变率最高(3.00%,8/267)。4种NRTIs相关、3种NNRTIs相关和1种PIs相关的耐药突变位点在不同亚型的流行率存在显著差异(P<0.05)。结论桂林市HIV/AIDS患者抗病毒治疗效果良好,耐药发生率总体较低,但未来仍需加强监测,减少耐药株的传播。

ObjectiveTo explore the HIV-1 drug resistance in patients with HIV/AIDS in Guilin city following the failure of antiretroviral treatment(ART).MethodsPlasma samples were collected from patients in Guilin who had received ART for more than 1 year and had a HIV viral load greater than or equal to 1000 copies/ml from January 2019 to December 2023,and demographic information was also collected for HIV-1 genotype subtype analysis and drug resistance testing to determine the resistance mutation loci and the susceptibility of the strains to drugs.ResultsA total of 766 patient samples with failed ART collection and successful amplification were collected,of which 536(69.97%,536/766)were male,with an average age of 53 years;a total of 8 HIV-1 subtypes were detected,with CRF01_AE(80.55%,617/766),CRF07_BC(11.10%,85/766)and CRF08_BC(6.92%,53/766)predominated.The drug resistance analysis showed that the HIV-1 drug resistance rate was 34.86%(267/766),including nucleoside reverse transcriptase inhibitors(NRTIs),non-nucleoside reverse transcriptase inhibitors(NNRTIs)and protease inhibitor(PI),with dual resistance to NRTIs/NNRTIs(48.31%,129/267)and NNRTIs resistance(43.07%,115/267)predominantly.A total of 37 resistance mutation sites were detected,14 NRTIs-associated mutation sites mainly included M184V/I(47.57%,127/267),K65R(18.73%,50/267),K70E/N/T/G/R(13.11%,35/267),etc.,and 18 NNRTIs-associated mutation sites mainly included K103 N/R(56.93%,152/267),V179 D/E/T(21.72%,58/267),G190C/S/Q(17.23%,46/267),and V106I/M(16.85%,45/267),etc.;and 5 PIs-associated mutation sites was the highest with L10V/I mutation rate(3.00%,8/267).ConclusionsHIV/AIDS patients in Guilin have shown favorable outcomes in antiviral therapy,with a relatively low overall incidence of drug resistance.However,it is essential to enhance surveillance to reduce the spread of drug-resistant strains in the future.