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目的了解四川省达州市接受艾滋病抗病毒治疗的I型艾滋病病毒(HIV-1)感染者的耐药现状及耐药株亚型特征,为预防耐药株的发生和流行提供依据。方法采集2013年全市范围内接受12个月以上抗病毒治疗的938名HIV-1感染者抗凝全血,检测病毒载量,对>1 000 cps/ml的标本进行PCR和pol基因测序,所得序列构建系统进化树分析亚型;并利用Stanford HIV Drug Resistance Database在线分析确定耐药突变情况。结果 938例接受抗病毒治疗感染者中,140例(14.93%)病毒载量>1 000 cps/ml,92例扩增阳性,44例出现不同程度耐药,经换算后耐药率为7.14%,比2011年高出3.15个百分点;44例耐药样本中,28例(63.64%)对核苷类逆转录酶抑制剂(NRTIs)类药物耐药,42例(34.09%)对非核苷类逆转录酶抑制剂(NNRTIs)类药物耐药,27例(61.36%)对NRTIs和NNRTIs两种药物同时耐药,1例(2.27%)对蛋白酶抑制剂(PIs)耐药。对耐药感染者标本进行基因型分析,以CRF01_AE重组亚型为主。结论 2013年达州市HIV-1耐药总体程度较2011年有所上升;对NNRTIs的高度耐药和交叉耐药较为严重,且首次出现了对PIs耐药的毒株。随着达州市抗病毒治疗工作开展时间延长,耐药株会逐渐增加,有必要加强耐药监测工作。
Objective To understand the drug resistance and subtype characteristics of drug-resistant strains of HIV-1 infected with AIDS virus in Dazhou, Sichuan Province, and to provide basis for preventing the occurrence and spread of drug-resistant strains. Methods A total of 938 HIV-1 infected patients receiving anticoagulant therapy for 12 months or more in the city were enrolled in 2013. The viral load was tested. PCR and pol gene sequencing were performed on specimens> 1000 cps / ml Sequence construction of phylogenetic tree analysis of subtypes; and the use of Stanford HIV Drug Resistance Database online analysis of drug resistance mutations identified. Results Of the 938 HIV-infected patients, 140 cases (14.93%) had viral load> 1000 cps / ml, 92 cases were positive for amplification and 44 cases were resistant to different degrees. The drug resistance after conversion was 7.14% , Which was 3.15 percentage points higher than that of 2011. Of the 44 drug-resistant samples, 28 (63.64%) were resistant to nucleoside reverse transcriptase inhibitors (NRTIs) and 42 (34.09%) were non-nucleoside NNRTIs were resistant to drugs, 27 (61.36%) were resistant to both NRTIs and NNRTIs, and 1 (2.27%) were resistant to protease inhibitors (PIs). Genotype analysis of drug-resistant infected specimens to CRF01_AE recombinant subtype based. Conclusion The overall level of HIV-1 resistance in Dazhou increased in 2013 as compared with that in 2011. The drug resistance and cross-resistance to NNRTIs were more serious, and for the first time, strains resistant to PIs appeared. With the development of antiviral treatment in Dazhou, the resistant strains will gradually increase, and it is necessary to strengthen the monitoring of drug resistance.