摘要
目的了解上海市浦东新区近年来中老年人群中未经抗病毒治疗的新确诊感染者HIV-1分子流行特征及耐药情况,为艾滋病防治策略制定提供科学依据。方法对2018-2021年期间浦东新区确诊实验室HIV-1抗体首次确诊阳性的50岁及以上患者开展面对面访谈,并同步收集血浆标本,采用反转录聚合酶链式反应(RT-PCR)扩增HIV-pol基因,进行基因亚型及耐药位点分析。结果获216份HIV-pol区基因全序列片段,HIV-1基因亚型主要有CRF07_BC(46.30%)、CRF01_AE(31.02%)、CRF08_BC(6.48%)、CRF55_01B(1.39%)、B(4.63%)、C(5.09%)、URFs(4.17%);感染途径主要为同性性传播(41.20%,89/216)、异性性传播(57.87%,125/216),其中流行株CRF01_AE的同性和异性性传播占比均为49.25%(33/67)、CRF07_BC同性和异性性传播分别占比45.00%(45/100)、54.00%(54/100),不同性传播途径的病毒亚型分布差异有统计学意义(χ^(2)=18.022,P=0.004);耐药分析发现此人群耐药率为5.09%,其中NNRTI为1.85%、NRTI为2.78%、PIs为0.93%,但中高度耐药情况只发生于CRF01_AE(2/5)和CRF07_BC(3/5)重组毒株中。结论浦东新区2018-2021年期间50岁及以上新确诊HIV-1感染者中,基因亚型主要以CRF07_BC和CRF01_AE为主,但已出现新的重组毒株如CRF08_BC、CRF55_01B以及URFs,呈现多元变化趋势;且存在治疗前耐药,建议加强50岁及以上中老年人群的宣传教育和监测力度,并免费开展抗病毒治疗前的耐药突变位点监测。
Objective To explore the molecular epidemiological characteristics and drug resistance of HIV-1 among newly diagnosed HIV-infected persons who had not received antiretroviral treatment(ART)in the middle-aged and elderly population in Pudong New Area,Shanghai,in recent years,so as to provide a scientific basis for HIV prevention and treatment strategies.Methods Face-to-face interviews were conducted with patients aged 50 years or older who were confirmed positive for HIV-1 antibodies for the first time by confirmatory laboratories in Pudong New Area between 2018 and 2021.Meanwhile,plasma specimens were also collected,and the HIV-pol gene was amplified using reverse transcription polymerase chain reaction(RT-PCR)for genetic subtype and drug resistance site analysis.Results A total of 216 full sequence fragments of the HIV-pol gene were obtained.The main genetic subtypes of HIV-1 were CRF07_BC(46.30%),CRF01_AE(31.02%),CRF08_BC(6.48%),CRF55_01B(1.39%),subtype B(4.63%),subtype C(5.09%),and unique recombinant forms(URFs,4.17%).The main routes of infection were homosexual transmission(41.20%,89/216)and heterosexual transmission(57.87%,125/216).Among the subtypes,both homosexual and heterosexual transmissions accounted for 49.25%(33/67)of the circulating CRF01_AE strain,while homosexual and heterosexual transmissions accounted for 45.00%(45/100)and 54.00%(54/100),respectively for CRF07_BC.Statistically significant differences were identified in the distribution of viral subtypes between different routes of sexual transmission(χ^(2)=18.022,P=0.004).Analysis of drug resistance revealed that the drug resistance rate among this population was 5.09%,including 1.85%against non-nucleoside reverse transcriptase inhibitors(NNRTIs),2.78%against nucleoside reverse transcriptase inhibitors(NRTIs),and 0.93%against protease inhibitors(PIs).However,medium to high resistance was only seen in the recombinant strains CRF01_AE(2/5)and CRF07_BC(3/5).Conclusions Among patients with newly diagnosed HIV-1 infections aged 50 years or older in Pudong New Area between 2018 and 2021,the main genetic subtypes were CRF07_BC and CRF01_AE.However,new recombinant strains such as CRF08_BC,CRF55_01B,and URFs were also observed,indicating a diversified pattern of change.Moreover,the presence of pre-treatment drug resistance was observed.We recommend enhancing the publicity,education,and disease surveillance for HIV/AIDS among the middle-aged and elderly population,and delivering free surveillance testing for drug-resistant mutation sites before antiviral treatment.
作者
汤琰
刘乾乾
王绪琴
李漾
邓冠聪
陈盼盼
辛辛
肖绍坦
TANG Yan;LIU Qianqian;WANG Xuqin;LI Yang;DENG Guancong;CHEN Panpan;XIN Xin;XIAO Shaotan(Shanghai Pudong New Area Center for Disease Control and Prevention,Shanghai 200136,China;Pudong Institute of Prevention Medicine,Fudan University,Shanghai 200136,China;Shanghai Municipal Center for Disease Control and Prevention.Shanghai 200336,China)
出处
《中国艾滋病性病》
CAS
CSCD
北大核心
2023年第10期1125-1129,共5页
Chinese Journal of Aids & STD
基金
上海市卫生健康委员会面上资助项目(202040477)
浦东新区卫生系统医学学科建设资助(PWYgts2021-04)。
关键词
艾滋病病毒
中老年人群
艾滋病病毒-pol基因
基因亚型
human immunodeficiency virus(HIV-1)
middle-aged and elderly population
HIV-pol gene
genetic subtypes
