摘要
目的了解上海市新确诊人类免疫缺陷病毒(human immunodeficiency virus,HIV)1型感染者的耐药情况,为临床抗逆转录病毒治疗(antiretroviral therapy,ART)提供参考依据。方法收集2023年4—6月上海市公共卫生临床中心根据纳入和排除标准筛选出的所有196例新确诊HIV-1感染者外周静脉血血浆,提取HIV-1 RNA,采用逆转录-聚合酶链式反应(reverse transcription-polymerase chain reaction,RT-PCR)扩增pol区进行序列测定,对突变位点及ART药物耐药情况进行分析。结果196例新确诊HIV-1感染者血浆中,成功扩增162份pol区基因序列(扩增成功率为82.65%),亚型由CRF07_BC(51.23%)、CRF01_AE(27.78%)、其他(6.79%)、CRF55_01B(5.56%)、B(3.70%)、CRF01_AE/B(3.70%)、CRF08_BC(1.23%)构成。总体传播性耐药率为7.41%,蛋白酶抑制剂(protease inhibitors,PIs)、非核苷类反转录酶抑制剂(non-nucleoside reverse transcriptase inhibitors,NNRTIs)、核苷类反转录酶抑制剂(nucleotide reverse transcriptase inhibitors,NRTIs)、整合酶抑制剂(integrase inhibitors,INSTIs)耐药率分别为3.09%、3.70%、0.00%和0.62%。B(66.67%)和CRF55_01B(88.89%)中出现NNRTIs相关突变位点的比例多于CRF07_BC(13.25%),CRF55_01B(88.89%)中出现NNRTIs相关突变位点的比例多于CRF01_AE(22.22%)和其他亚型(18.18%),差异具有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,CRF01_AE/B出现PIs相关突变位点的可能性是CRF07_BC的21.71倍[比值比(odds ratio,OR)=21.71,95%置信区间(confidence interval,CI):3.36~140.27,P=0.001]。结论上海市新确诊HIV-1感染者中传播性耐药处于中度流行水平,以NNRTIs和PIs相关耐药为主,INSTIs耐药率较低,应考虑在ART方案中使用INSTIs。
ObjectiveTo investigate the drug resistance of newly diagnosed HIV-1 infected patients in Shanghai and to provide reference value for clinical antiretroviral therapy(ART).MethodsThe peripheral venous blood plasma of 196 newly diagnosed HIV-1 infected patients screened according to the inclusion and exclusion criteria at the Shanghai Public Health Clinical Center from April to June 2023 was collected,HIV-1 RNA was extracted,the pol region was amplified by reverse transcription-polymerase chain reaction(RT-PCR)for sequencing,the mutation sites and ART drug resistance were analyzed.ResultsThe plasma of 196 newly diagnosed HIV-1 infected patients was amplified successfully in 162 cases(amplification success rate was 82.65%).The subtypes consisted of CRF07_BC(51.23%),CRF01_AE(27.78%),and others(6.79%),CRF55_01B(5.56%),B(3.70%),CRF01_AE/B(3.70%)and CRF08_BC(1.23%).The overall transmitted drug resistance rate was 7.41%,the protease inhibitors(PIs),non-nucleoside/nucleotide reverse transcriptase inhibitors(NNRTIs),nucleoside/nucleotide reverse transcriptase inhibitors(NRTIs),integrase inhibitors(INSTIs)resistance rates were 3.09%,3.70%,0.00%and 0.62%,respectively.The proportion of NNRTIs-related mutation sites in B(66.67%)and CRF55_01B(88.89%)was higher than that in CRF07_BC(13.25%);the proportion of NNRTIs-related mutation sites in CRF55_01B(88.89%)was higher than that in CRF01_AE(22.22%)and other subtypes(18.18%),the difference was statistically significant(all P<0.05).Multivariate logistic regression analysis showed that the probability of PIs-related mutation sites in CRF01_AE/B was 21.71 times that of CRF07_BC[odds ratio(OR)=21.71,95%confidence interval(CI):3.36-140.27,P=0.001].ConclusionsThe transmitted drug resistance among newly diagnosed HIV-1 infected patients in Shanghai is at the moderate epidemic level,mainly NNRTIs and PIs-related drug resistance,and the INSTIs resistance rate is low,the use of INSTIs in ART regimens should be considered.
作者
林倩茹
王绪琴
唐雯琪
董原
岳清
何春燕
郁晓磊
刘长河
韩逸清
冯琬清
宁镇
沈鑫
陈昕
林怡
Lin Qianru;Wang Xuqin;Tang Wenqi;Dong Yuan;Yue Qing;He Chunyan;Yu Xiaolei;Liu Changhe;Han Yiqing;Feng Wanqing;Ning Zhen;Shen Xin;Chen Xin;Lin Yi(Shanghai Municipal Center for Disease Control and Prevention,Shanghai 200336,China)
出处
《中华实验和临床病毒学杂志》
2025年第1期69-74,共6页
Chinese Journal of Experimental and Clinical Virology
基金
上海市加强公共卫生体系建设三年行动计划(2023-2025年)重点学科项目(GWVI-11.1-05)。
