摘要
目的 了解云南省HIV-1 CRF01_AE毒株的流行分布及基因型耐药情况。方法 收集2018—2021年云南省抗病毒治疗失败的HIV/AIDS患者的人口学资料,采集患者血浆,逆转录聚合酶链反应扩增HIV-1 pol基因蛋白酶和逆转录酶区并进行序列测定,对基因型为CRF01_AE的序列进行耐药情况分析。结果 通过基因型耐药检测共获得967例亚型为CRF01_AE序列,其中男性682例(占70.5%),耐药509例,耐药率为52.6%,异性性传播813例(占84.1%),同性性传播95例(占9.8%)。同性性传播的耐药率最高,为65.3%;治疗时长<12个月的耐药率最低,为35.9%,36~<48个月耐药率最高,为58.1%。核苷类反转录酶抑制剂(NRTIs)耐药率为33.9%,非核苷类反转录酶抑制剂(NNRTIs)的耐药率为48.5%,蛋白酶抑制剂(PIs)的耐药率较低为1.3%。NRTIs类药物中阿巴卡韦(ABC)、恩曲他滨(FTC)和拉米夫定(3TC)耐药率较高,分别为为32.9%、32.4%和32.4%;NNRTIs类药物中奈韦拉平(NVP)和依非韦仑(EFV)耐药率较高,分别为47.6%和47.5%,均以高度耐药为主。一线治疗方案耐药率56.2%高于二线治疗方案耐药率29.5%,差异有统计学意义(P<0.001)。NRTIs耐药突变位点中,以M184V/I突变位点为主,突变率为30.0%;NNRTIs耐药突变位点中,以K103N/Q/S突变位点为主,突变率为28.1%;PIs耐药位点突变率相对较低,主要的耐药突变位点是L33F,突变率为3.7%。结论 云南省抗病毒治疗失败亚型CRF01_AE的患者耐药率有所降低,但部分地区及人群的耐药率仍较高,应加强对重点地区和人群的管理,加强耐药监测,对治疗失败的患者及时掌握耐药情况,合理调整治疗方案。
Objective To study the prevalence distribution and genotypic drug-resistance of HIV-1 CRF01_AE in Yunnan Province.Methods The demographic data and plasma of HIV/AIDS patients who failed antiviral treatment in Yunnan Province from 2018 to 2021 were collected.The HIV-1 pol gene protease and the reverse transcriptase region were amplified using the reverse transcriptase chain reaction and the sequences were determined.Drug-resistance of the CRF01_AE subtype was analyzed.Results In this study,a total of 967 subtype sequences of CRF01_AE were obtained through genotype resistance detection.The resistance rate in this population was 52.6%,509 cases.Among them,the gender was dominated by men which was 70.5%,682 cases,and the main route of transmission was heterosexual transmission which was 84.1%,813cases.Homosexual transmission accounted for 9.8%,95 cases,however,the drug resistance rate of homosexual transmission was 65.3% which was the highest among several modes of transmission.The drug resistance rate was lowest (35.9%) when the treatment duration was less than 12 months,and the drug resistance rate was the highest (58.1%) when the treatment duration was 36-<48 months.The resistance rate of nucleoside reverse transcriptase inhibitors (NRTIs) was 33.9%,the rate of nonnucleoside reverse transcriptase inhibitors (NNRTIs) was 48.5%,and the rate of protease inhibitors (PIs) was 1.3%.Among NRTIs,the drug resistance rates of abacavir (ABC),emtricitabine(FTC) and lamivudine (3TC) were higher,which were 32.9%,32.4% and 32.4%respectively.Among NNRTIs,nevirapine (NVP) and efavirenz (EFV) had higher drug resistance rates,which were 47.6% and 47.5%respectively,and they were mainly high-level drug resistance.The drug resistance rate of first-line treatment (56.2%) was higher than that of second-line treatment (29.5%).M184V/I was the main drug resistance mutation site in NRTIs,and the mutation rate was 30.0%.K103N/Q/S was the main drug resistance mutation site in NNRTIs,and the mutation rate was 28.1%.The mutation rate of PIs drug resistance sites was lower,and the main drug resistance mutation site was L33F,with a mutation rate of 3.7%.Conclusions Although the drug resistance rate of CRF01_AE subtype patients who failed antiviral therapy in Yunnan Province had decreased,the drug resistance rate was still higher in some areas and populations.The management of key areas and populations,and drug resistance monitoring should be strengthened.For patients who had failed treatment,the drug resistance situation should be grasped in time,and the treatment plans should be adjusted reasonably.
作者
张芮
刘家法
张米
李健健
邓雪媚
马莎
李梦学
董兴齐
ZHANG Rui;LIU Jia-fa;ZHANG Mi;LI Jian-jian;DENG Xue-mei;MA Sha;LI Meng-xue;DONG Xing-qi(School of Public Health,Kunming Medicine University,Kunming,Yunnan 650000,China;Department of Laboratory,Yunnan Provincial Infectious Diseases Hospital,Kunming,Yunnan 650301,China)
出处
《中国热带医学》
CAS
2022年第7期597-602,628,共7页
China Tropical Medicine
基金
云南省重大科技专项计划(No.202102AA310005)
云南省高层次卫生技术人才培养经费资助项目(No.H-2019047)。
