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目的观察北京地区未经抗病毒治疗的艾滋病病毒(HIV)感染者HIV-1毒株耐药基因的变异情况,用于指导临床用药。方法以2014年4-7月北京地区601例未经抗反转录病毒治疗的HIV感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)为对象。采集病人的静脉血,提取血浆病毒核糖核酸(RNA),用反转录/巢式聚合酶链式反应扩增病毒pol基因,并进行序列测定和亚型分析。在Stanford University HIV耐药数据库查询,分析是否存在基因型耐药以及耐药种类。结果 601例未经抗反转录病毒治疗的HIV/AIDS病人中,扩增成功的458例,其中男性434例(94.8%),女性24例(5.2%);平均年龄33岁(17~77岁)。主要感染亚型依次为CRF01_AE(211例,46.1%)、CRF07_BC(126例,27.5%)、B亚型(106例,23.1%)和C亚型(15例,3.3%)。在扩增成功的病人中,7.4%(34/458)的病人存在原发耐药基因变异,其中7例病人对核苷类反转录酶抑制剂(NRTIs)耐药,16例病人对非核苷类反转录酶抑制剂(NNRTIs)耐药,8例对蛋白酶抑制剂(PIs)耐药,3例病人同时对NRTIs和NNRTIs耐药。结论北京地区未经治疗的HIV/AIDS病人中,有部分病人存在原发耐药基因变异,极少数病人同时存在对两种主要治疗药物耐药,因此治疗前需要根据耐药检测结果制定用药方案,有助于提高治疗有效率,避免治疗失败。
Objective To observe the variation of drug resistance genes of HIV-1 strains in HIV-infected non-HIV-infected patients in Beijing and to guide clinical application. Methods A total of 601 HIV / AIDS patients (referred to as HIV / AIDS patients) without antiretroviral therapy in Beijing area from April to July 2014 were enrolled. The patient’s venous blood was collected, the plasma viral RNA (RNA) was extracted, and the pol gene of the virus was amplified by reverse transcription / nested polymerase chain reaction and sequenced and subtype analyzed. Check out the Stanford University HIV Resistance database for genotypic resistance and resistance patterns. Results A total of 458 HIV / AIDS patients without antiretroviral therapy were enrolled in this study. Among them, 434 (94.8%) were male and 24 (5.2%) were female. The mean age was 33 years (ranged from 17 to 77 year old). The main subtypes of infection were CRF01_AE (211 cases, 46.1%), CRF07_BC (126 cases, 27.5%), B subtype (106 cases, 23.1%) and C subtype (15 cases, 3.3%). Among the patients with successful amplification, 7.4% (34/458) had primary resistance gene mutations, of which 7 patients were resistant to nucleoside reverse transcriptase inhibitors (NRTIs) and 16 patients were non-nuclear Resistant to glycoside reverse transcriptase inhibitors (NNRTIs), 8 were resistant to protease inhibitors (PIs) and 3 patients were resistant to both NRTIs and NNRTIs. Conclusions In untreated HIV / AIDS patients in Beijing, there are some patients with primary resistance gene variation. In the very few patients, there are two kinds of major therapeutic drug resistance at the same time. Therefore, the treatment plan should be based on the drug resistance test results before treatment , Help to improve the treatment efficiency, to avoid treatment failure.