摘要
目的了解河北省接受抗逆转录病毒治疗(ART)HIV/AIDS患者的HIV-1基因亚型、耐药特征及其耐药影响因素,为HIV/AIDS患者实施精准治疗提供指导。方法收集2023年1—12月在河北省接受6个月以上ART的HIV/AIDS患者血浆样本进行病毒载量(VL)检测,对VL≥50 copies/mL的样本进行HIV-1 pol基因扩增,判定亚型并进行耐药分析,非条件Logistic回归进行耐药影响因素分析。结果扩增成功的612例患者中,HIV-1毒株以CRF01_AE、CRF07_BC为主,B、CRF08_BC、CRF65_cpx、URFs等多亚型并存。总耐药率为37.75%(231/612),其中病毒学抑制失败(VF)患者耐药率为44.59%(165/370),低病毒血症(LLV)患者耐药率为27.27%(66/242)。抗病毒治疗药物中NNRTIs(35.13%)、NRTIs(23.37%)耐药率明显高于PIs耐药率(1.80%),且NNRTIs-NRTIs双重耐药情况较为频繁。Logistic回归分析发现耐药发生风险与CD4^(+)T淋巴细胞计数、基因亚型以及VL有关,CD4^(+)T淋巴细胞计数水平越低耐药发生风险越高,CRF07_BC相较于CRF01_AE耐药风险低(aOR=0.384,95%CI:0.248~0.593),VF耐药风险高于LLV。结论河北省接受ART的HIV/AIDS患者耐药风险较高,对接受ART的HIV/AIDS患者应进行及时的病毒载量及耐药监测,为实施精准治疗提供指导。
This study analyzed the characteristics of the genotypes and drug resistance in patients with HIV/AIDS receiving antiretroviral therapy(ART)in Hebei Province,to provide guidance for accurate high-quality HIV/AIDS treatment.Plasma samples were collected from patients with HIV/AIDS who had received ART for more than 6 months and had a viral load≥50 copies/mL between January and December of 2023 in Hebei Province,The HIV-1 pol gene(1.3 kb)was amplified with nested reverse transcription polymerase chain reaction,and the sequencing results were submitted to the HIV drug resistance database to analyze drug resistance mutations.Factors influencing drug resistance were analyzed with logistic regression.Among 612 patients with HIV/AIDS,the HIV-1 strains consisted primarily of subtypes CRF01_AE and CRF07_BC.Multiple subtypes,such as B,CRF08_BC,CRF65_cpx,and URFs,were found to coexist.The overall resistance rate was 37.75%(231/612).The resistance rate of patients with virological failure(VF)was 44.59%(165/370),whereas the resistance rate of patients with low-level viremia(LLV)was 27.27%(66/242).Among the antiretroviral drugs,the drug resistance rates for NNRTIs(35.13%)and NRTIs(23.37%)were significantly higher than those for PIs(1.80%).Dual drug resistance to NNRTIs and NRTIs occurred relatively frequently.Multivariate logistic regression analysis indicated that CD4^(+)T-lymphocyte count,genotype,and viral load were associated with HIV-1 drug resistance.Lower CD4^(+)T-lymphocyte counts were associated with greater risk of drug resistance.Compared with CRF01_AE,CRF07_BC had a lower risk of drug resistance(aOR=0.384,95%CI:0.248-0.593),and the drug resistance risk of patients with VF was higher than that of patients with LLV.Therefore,patients with HIV/AIDS receiving ART in Hebei Province have a relatively high risk of drug resistance.These patients should receive timely monitoring and high-quality precision intervention therapy.
作者
刘萌
李岩
王莹莹
安宁
徐雪昂
孙丹丹
张玉琪
路新利
LIU Meng;LI Yan;WANG Yingying;AN Ning;XU Xueang;SUN Dandan;ZHANG Yuqi;LU Xinli(Department of STD and AIDS Research,Hebei Provincial Center for Disease Control and Prevention,Hebei Key Laboratory of Pathogen and Epidemiology of Infectious Disease,Shijiazhuang 050021,China;College of Public Health,Hebei Medical University,Shijiazhuang 050017,China)
出处
《中国人兽共患病学报》
北大核心
2025年第11期1192-1198,共7页
Chinese Journal of Zoonoses
基金
河北省医学科学研究课题计划(No.20220048)。
关键词
HIV-1
抗病毒治疗
基因亚型
耐药分析
HIV-1
antiretroviral therapy
gene subtype
drug resistance analysis
