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目的了解上海市2007-2013年HIV-1感染者的原发耐药基因突变情况,掌握耐药毒株变化趋势。方法随机选取2007-2013年随访的常住上海未经抗病毒治疗的HIV-1感染者血浆标本1296例,进行反转录-聚合酶链反应(RT-PCR)扩增、DNA测序、亚型鉴定,并与国际HIV耐药数据库比对分析。结果获得1085例pol区基因片段,其中亚型分布显示,CRF01_AE 651例(60.0%),其次为CRF07_BC 253例(23.3%)、B亚型97例(8.9%)、CRF08_BC52例(4.8%)、C亚型12例(1.1%)、CRF01_B 10例(0.9%)、F2亚型2例(0.2%)、G亚型2例(0.2%)、CRF02_AG 5例(0.5%)和CRF03_AB 1例(0.2%)。原发耐药率平均为1.4%,其中核苷类反转录酶抑制剂(NRTI)耐药相关突变率为0.3%(3/1085),非核苷类反转录酶抑制剂(NNRTI)耐药相关突变率为0.9%(9/1085),整合酶抑制剂(IN)耐药相关突变率为0.2%(2/1085)。同时发生对蛋白酶抑制剂(PIs)和NNRTIs的耐药相关突变1例。结论 2007 2013年上海市HIV-1感染者中存在原发耐药基因变异,耐药率呈下降趋势,从2007年的4.5%下降到2013年的1.1%。耐药基因型以CRF01_AE为主,男男同性传播为主,极少数HIV感染者同时存在对2种主要治疗药物耐药,应加强CRF01_AE耐药毒株的动态监测和研究,尤其是在男男性接触人群中的变化趋势。
Objective To understand the mutations of primary drug resistance genes in HIV-1-infected persons in Shanghai from 2007 to 2013 and to find out the trend of drug-resistant strains. Methods A total of 1296 HIV-1 infected non-antiviral HIV-1 patients from 2007 to 2013 in our country were randomly selected for RT-PCR amplification, DNA sequencing and subtype identification , And compared with the international HIV drug resistance database. RESULTS: A total of 1085 pol loci were obtained, of which 651 (60.0%) were CRF01_AE followed by 253 (23.3%) CRF07_BC, 97 (8.9%) B and 97 (4.8%) CRF08_BC, C subtype in 12 cases (1.1%), CRF01_B in 10 cases (0.9%), F2 subtype in 2 cases (0.2%), G subtype in 2 cases (0.2%), CRF02_AG in 5 cases (0.5%) and CRF03_AB in 1 case 0.2%). The primary drug resistance rate was 1.4% on average, of which the NRTI resistance-associated mutation rate was 0.3% (3/1085) and the non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance rate The drug-related mutation rate was 0.9% (9/1085), and the integrase inhibitor (IN) drug-resistant mutation rate was 0.2% (2/1085). One case of mutation associated with protease inhibitors (PIs) and NNRTIs was also found. Conclusion In 2007, there was a variation of primary drug resistance genes among HIV-1 infected persons in Shanghai. The drug resistance rate showed a downward trend from 4.5% in 2007 to 1.1% in 2013. The resistant genotypes were predominantly CRF01_AE and were mainly transmitted by same-sex men and women. Few HIV-infected patients were simultaneously resistant to the two major therapeutic agents. Dynamic surveillance and study of CRF01_AE resistant strains should be strengthened, especially in men who have sex with men Trends in exposure to the population.