摘要
目的 了解德宏傣族景颇族自治州(德宏州)2017—2019年新报告人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染者治疗前HIV耐药突变位点情况及影响耐药发生的相关社会因素,为减少HIV感染者耐药发生,合理抗病毒治疗提供科学依据。方法 采用横断面研究方法,对德宏州2017—2019年新报告HIV感染者血浆样本提取核酸并扩增pol基因片段,确定耐药突变位点。收集HIV感染者的疫情卡片及社会人口学特征,运用构成比、均数和标准差或中位数和四分位间距(interquartile, IQR)等描述研究对象社会人口学特征及实验室指标情况,采用多因素logistic回归分析耐药发生的影响因素。结果 2017—2019年德宏州新报告HIV感染者共3 278例,对首次确证阳性患者样本剩余血浆量≥200μl的2 346例进行耐药检测,有1 796例感染者的样本获得pol基因序列,其中,男性感染者1 216例(67.7%)、异性传播1 414例(78.7%)、中国籍感染者674例(37.5%)。2017—2019年新报告HIV感染者治疗前总体耐药率达7.1%(127/1 796)。多因素logistic回归分析结果显示,在中国籍和缅甸籍HIV感染者中,发生耐药的影响因素有CRF01_AE亚型(OR=0.28,95%CI:0.08~0.99)、景颇族(OR=8.67,95%CI:1.13~66.39)、傣族(OR=11.99,95%CI:1.56~92.22)以及自愿咨询检测发现的感染者(OR=3.49,95%CI:1.21~10.08)。结论 德宏州2017—2019年新报告HIV感染者治疗前耐药发生率处于中度流行。中国籍感染者CRF01_AE亚型的发生耐药风险较低,而境内缅甸籍感染者中景颇族和傣族以及自愿咨询检测发现者发生耐药风险较高。
Objective To observe the pre-treatment drug mutations of pol gene in newly reported HIV/AIDS in Dehong Dai and Jingpo Autonomous Prefecture, Yunnan Province from 2017 to 2019, and to discuss related factors. Methods In a cross-sectional study, nucleic acid was extracted from plasma samples of newly reported HIV/AIDS and pol gene was amplified and sequenced to determine drug resistant profile.Meanwhile,clinical data and demographic information were collected and demographic characteristics and laboratory test parameters were described.Multivariate logistic regression model was used for influencing factor analysis. Results From 2017to 2019,out of 3 278newly reported HIV/AIDS,2 346were tested for drug resistance and HIVpol gene were successfully sequenced in 1 796subjects,among which,1 216(67.7%)were males,1 414(78.7%)were heterosexually transmitted cases,and 674(37.5%)were Chinese.The overall pretreatment drug resistance rate was 7.1%(127/1 796).Multivariate logistic regression analysis showed that,among HIV-infected Chinese and Burmese individuals,the presence of pre-treatment drug resistance was significantly associated with CRF01_AE subtype(OR=0.28,95%CI:0.08—0.99),Jingpo nationality(OR=8.67,95%CI:1.13—66.39),Dai nationality(OR =11.99,95%CI:1.56—92.22)and HIV infection identified during voluntary testing and counseling(VCT)visit(OR=3.49,95%CI:1.21—10.08). Conclusions The pre-treatment drug resistance rate is at medium level in Dehong Prefecture during 2017 and 2019.HIV-infected Chinese individuals with CRF01_AE subtype have a lower risk of drug resistance,while HIV-infected Burmese individuals with Jingpo and Dai nationality and those who were confirmed HIV/AIDS during VCT visit have a higher risk of drug resistance.These provide more precise information for pretreatment drug resistance monitoring and subsequent ART initiation among HIV-infected individuals.
作者
段星
王妙辰
王译葵
杨锦
叶润华
周素娟
王继宝
杨涛
杨跃诚
姚仕堂
丁盈盈
何纳
段松
DUAN Xing;WANG Miao-chen;WANG Yi-kui;YANG Jin;YE Run-hua;ZHOU Su-juan;WANG Ji-bao;YANG Tao;YANG Yue-cheng;YAO Shi-tang;DING Ying-ying;HE Na;DUAN Song(Dehong Dai and Jingpo Autonomous Prefecture Center for Disease Control and Prevention,Mangshi,Yunnan 678400,China;不详)
出处
《中国病毒病杂志》
CAS
2022年第5期343-348,共6页
Chinese Journal of Viral Diseases
基金
国家科技重大专项(2018ZX10715006-001,2018ZX10721102-004)
国家重点地区艾滋病防治项目(卫办疾控发[2004]49号)。
