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目的观察2014~2015年吉林市内抗病毒治疗失败HIV-1感染者中HIV基因型耐药情况及其亚型分布。方法收集吉林市2014~2015年HIV-1感染者中接受抗病毒治疗后HIV病毒载量≥1 000拷贝/ml的患者血浆样本,提取病毒RNA,进行POL基因区扩增及测序后,使用美国斯坦福大学HIV耐药数据库进行耐药位点分析,Mega 6.0软件Neighbor-joining tree方法构建系统进化树,进行亚型分布分析。结果 2014~2015年275份抗病毒治疗失败人群血浆样本全部扩增成功,共发现106份基因型耐药样本,耐药率为38.5%,其中7份对蛋白酶类药物耐药,82份对核苷类药物耐药,99份对非核苷类药物耐药,有80份同时对核苷类和非核苷类药物耐药。核苷类逆转录酶区耐药位点以M184V/IV突变为主,非核苷类逆转录酶区耐药位点以G190G/A/S和V179D/E/G突变为主,2例蛋白酶类药物主要耐药突变位点分别为A71V/T和L10I/M/V。序列亚型以CRF01_AE为主(64.7%),主要流行簇以CRF01_AE第4、第5及CRF07_BC第1簇为主。结论耐药位点的出现是影响吉林市HIV感染者抗病毒治疗效果的一个重要原因,应加强对治疗失败患者的耐药监测,及时发现耐药突变,尽早更换药物。
Objective To investigate the HIV genotypes and their subtypes in HIV-1 infected patients who failed in antiviral therapy in Jilin City from 2014 to 2015. Methods Plasma samples from HIV-1 infected patients who were HIV-1 infected with HIV virus ≥1 000 copies / ml from 2014 to 2015 in Jilin City were collected, and the viral RNA was extracted. After amplifying and sequencing the POL gene region, Stanford University HIV resistance database for drug-resistant loci analysis, Mega 6.0 software Neighbor-joining tree method to build phylogenetic tree for subtype distribution analysis. Results A total of 275 plasma samples were successfully amplified from 275 antiviral treatment failure patients in 2014-2015. A total of 106 drug-resistant samples were found, with a resistance rate of 38.5%, of which 7 were resistant to protease drugs and 82 were anti- Glycosides drug-resistant, 99 were resistant to non-nucleoside drugs, 80 were resistant to both nucleoside and non-nucleoside drugs. Nucleotide reverse transcriptase resistance sites to M184V / IV mutation predominant non-nucleoside reverse transcriptase resistance sites G190G / A / S and V179D / E / G mutations mainly two cases of proteases The main drug-resistant mutation sites were A71V / T and L10I / M / V, respectively. The majority of the subtypes were CRF01_AE (64.7%), and the major ones were the 4th, 5th and CRF07_BC cluster 1 of CRF01_AE. Conclusion The emergence of drug-resistant loci is an important reason for the effect of antiviral therapy in HIV-infected patients in Jilin City. Drug-resistant surveillance should be strengthened in patients with failed treatment, and drug-resistant mutations should be detected in time to replace the drug as soon as possible.