2022—2023年西安市初始抗病毒治疗病例HIV-1基因耐药特征分析

HIV-1 genotypic drug resistance among patients before initial antiretroviral therapy in Xi'an,2022-2023

目的分析2022—2023年西安市接受初始抗逆转录病毒治疗病例治疗前HIV-1基因耐药特征及亚型分布情况。方法募集2022年5月至2023年3月西安市初始ART病例,采集静脉抗凝全血303份,提取病毒RNA,经反转录和巢式PCR扩增HIV-1pol基因片段,进行Sanger测序。获得的pol基因片段序列经COMET HIV-1判断亚型,并经Los Alamos国家实验室HIV BLAST和RIP工具验证亚型。用斯坦福大学HIV耐药数据库HIVdb Program工具对序列信息进行耐药解析。结果303例样本PCR扩增成功并获得pol基因片段序列260例。共检测到10种亚型或流行重组型,以CRF07BC为主(55.77%),其次为CRF01AE(32.69%)、CRF5501B(4.62%)和B亚型(2.69%)。20例存在治疗前耐药相关突变(DRMs)并对一线治疗药物存在低度到高度耐受,总体治疗前耐药率为7.69%。CRF01AE毒株耐药占比最高(3.46%);其次是CRF07BC(1.92%)和CRF5501B(1.15%)。非核苷类逆转录酶抑制剂耐药发生率最高,以依非韦伦和奈韦拉平药物耐药发生最常见。结论西安市治疗前HIV-1基因型耐药发生水平较高(7.69%),应加强治疗前耐药监测检测,分析HIV-1耐药毒株传播来源,为临床用药和个体化治疗提供数据支持。

ObjectiveTo explore the HIV-1 genotypic drug resistance characteristics and subgenotype distribution among HIV-1-infected patients before initial antiretroviral therapy(ART)from 2022 to 2023 in Xi'an city.MethodsInitial ART cases from May 2022 to March 2023 in Xi’an were recruited.Three hundred and three anticoagulated venous whole bloods were collected.The nucleic acid was extracted,reversely transcripted,and pol gene segment was amplified by reverse transcription and nested PCR followed by Sanger sequencing.The subgenotypes based on the obtained pol sequences were determined by COMET HIV-1 and confirmed by the HIV BLAST and RIP tools of Los Alamos National Laboratory.Sequence information was resolved for drug resistance using HIVdb Program tool of the Stanford University HIV Drug Resistance Database.ResultsFrom the 303 specimens,pol gene was amplified and sequenced successfully in 260 samples.Ten subgenotypes or circulating recombinant forms(CRFs)were detected.The dominant type was CRF07_BC(55.77%)followed by CRF01_AE(32.69%),CRF55_01B(4.62%),and B subgenotype(2.69%).In the analysis,20 cases had resistance-associated mutations(DRMs)before therapy and were highly resistant to first-line drugs.The overall pre-treatment resistance rate of 7.69%.The proportion of drug resistance in CRF01 AE was the highest(3.46%),followed by CRF07_BC(1.92%)and CRF55_01B(1.15%).The incidence of resistance to non-nucleoside reverse transcriptase inhibitors was the highest and the most common were resistance to efavirenz and nevirapine.ConclusionsOverall,pre-treatment HIV-1 genotypic drug resistance was relatively high(7.69%)in Xi'an.It is recommended to improve surveillance of pre-treatment drug resistance to analyze the sources of HIV-1 resistant strains and provide data support for the clinical use of medication and personalized treatment.