摘要
目的监测湖州市2021-2024年新诊断HIV/AIDS患者HIV-1毒株分子网络特征,动态分析网络增长变化及影响因素,为精准干预提供科学依据。方法收集2021-2024年新诊断(未接受cART)的HIV/AIDS患者血样,采用反转录-聚合酶链式反应(RT-PCR)和巢式-聚合酶链式反应(Nested-PCR)方法扩增HIV-1的pol区基因并测序,采用MEGA7.0软件构建系统进化树分析亚型,Cytoscape3.10.3软件生成分子网络,Logistic回归模型对入网率的影响因素进行分析。结果获得692条HIV-1pol区基因序列,发现9种流行重组型亚型和4种独特重组型亚型,主要亚型为CRF07_BC为356例(51.45%),CRF01_AE为164例(23.70%)和CRF08_BC为86例(12.43%)。在1.2%阈值共形成87个分子簇,325条序列入网,入网率为46.97%。Logistic回归分析显示:年龄≥50岁(OR=1.74,95%CI:1.72~2.13)和CRF01_AE(OR=0.66,95%CI:0.45~0.98)的感染者更容易入网。发现6个较大活跃分子簇,随诊断年份的推移而发生动态扩增,占整个网络病例数的39.08%(127/325)。以男性(80.31%,102/127)、≥50岁(65.35%,83/127)、异性传播途径感染(80.31%,102/127)为主,主要分布于D区(36.22%,46/127)和A县(25.20%,32/127)。分子簇C1、簇C2和簇C3中共包含4名阳性暗娼,分别有27.27%(12/44)、91.18%(31/34)、73.33%(11/15)及73.33%(11/15)患者和阳性暗娼的基因距离阈值≤1.2%。另外发现分子簇C5由10例青年MSM入网构成,现住址均聚集在A县的两个街道。结论湖州市HIV感染亚型多样化,CRF07_BC和CRF01_AE为主要流行亚型,2021-2024年HIV分子网络近年扩张较快且存在关键传播网络。以暗娼为中心的非婚商业异性性传播感染为主,≥50岁男性是分子网络中的活跃人群,应加强对关键聚集性病例的溯源和商业异性性行为的干预。另外还需加强20~45岁MSM的高风险人群的关注和有效管理。
Objective To monitor the molecular network characteristics of patients newly diagnosed with human immunodeficiency virus(HIV)/acquired immune deficiency syndrome(AIDS)in Huzhou City from 2021 to 2024,to dynamically analyze network growth changes and influencing factors,and provide a scientific basis for precise intervention.Method In total,736 blood samples were collected from newly diagnosed patients with HIV/AIDS who did not receive antiviral treatment between 2021 and 2024.Reverse transcription polymerase chain reaction(RT-PCR)and nested PCR were used to amplify and sequence the pol region gene of HIV-1.MEGA7.0 software was used to construct a phylogenetic tree for subtype analysis.Cytoscape 3.10.3 software was used to generate a molecular network,and a logistic regression model was used to analyze the factors affecting the network access rate.Results In total,692 HIV-1 pol gene sequences were obtained,revealing nine prevalent and four unique recombinant subtypes.The main subtypes were CRF07_BC(356 patients,51.45%),CRF01 AE(164 patients,23.70%),and CRF08 BC(86 patients,12.43%).At a 1.2%threshold,87 molecular clusters were formed with 325 sequences included in the network,representing a network inclusion rate of 46.97%.Logistic regression analysis showed that individuals aged≥50 years[odds ratio(OR)=1.74,95%confidence interval(CI):1.72-2.13]and those infected with CRF01 AE(OR=0.66,95%CI:0.45-0.98)were more likely to be included in the network.Six large and active molecular clusters were identified,which dynamically expanded over the years of diagnosis and accounted for 39.08%(127/325)of all network cases.The majority were male(80.31%,102/127),aged≥50 years(65.35%,83/127),infected through heterosexual transmission(80.31%,102/127),and mainly distributed in District D(36.22%,46/127)and County A(25.20%,32/127).Molecular clusters C1,C2,and C3 included four positive female sex workers,with 27.27%(12/44),91.18%(31/34),and 73.33%(11/15)of patients and positive female sex workers having a genetic distance threshold≤1.2%.Additionally,molecular cluster C5 was composed of 10 young MSM,all of whom resided on two streets of County A.Conclusions The subtypes of HIV infection in Huzhou City were diverse,with CRF07_BC and CRF01_AE being the predominant subtypes.The HIV molecular network has expanded rapidly in recent years,from 2021 to 2024,and there are key transmission networks.The infection mainly occurs through non-marital commercial heterosexual sex,centered on female sex workers.Men aged≥50 are active in the molecular network.It is necessary to strengthen the traceability of key clustered cases and interventions in commercial heterosexual behavior.Furthermore,more attention should be paid to the effective management of high-risk men who have sex with men aged 20-45 years.
作者
朱晓娟
卢忠豪
查赟峰
吴振乾
杨中荣
ZHU Xiaojuan;LU Zhonghao;CHA Yunfeng;WU Zhenqian;YANG Zhongrong(Huzhou Center for Disease Control and Prevention,Huzhou 313000,Zhejiang,China)
出处
《中国艾滋病性病》
北大核心
2025年第11期1186-1192,共7页
Chinese Journal of Aids & STD
基金
湖州市科技计划项目(2023GY30)。
