摘要
目的分析凉山州某县未接受抗病毒治疗的HIV-1感染者的传播性耐药(TDR)情况,为了解当地HIV-1耐药株的传播及抗反转录病毒治疗(ART)方案的制定提供理论依据和技术支撑。方法以来源于2022年1—8月在凉山州某县未接受ART的HIV-1感染者为研究对象,采集其血液样本并分离血浆和血细胞,血浆样本用于HIV-1 RNA定量检测和HIV-1 RNA基因型耐药检测,血细胞样本用于HIV-1 DNA定量检测和HIV-1 DNA基因型耐药检测。结果135例研究对象中,男性75例(55.6%),女性60例(44.4%),中位年龄37.5岁,彝族占比最大(96.3%)。性途径传播为HIV-1主要传播方式(83.0%)。发生TDR的有11例,发生率为8.1%。诊断HIV-1感染距耐药检测时间的中位数为11 d。HIV-1 RNA以10001~100000拷贝/mL占比较多(43.7%)。HIV-1 DNA以101~1000拷贝/106 cells占比较多(55.6%)。HIV-1亚型中,以B+C亚型重组占比最高(51.9%),其次为CRF07_BC重组型(43.0%)。135例研究对象中,有23例(17.0%)出现耐药突变位点,与非核苷类反转录酶抑制剂(NNRTI)有关的耐药突变位点有16例(11.9%),K103N是主要的耐药突变位点,依非韦伦和奈韦拉平是主要的耐药药物;与整合酶抑制剂(INSTI)有关的耐药突变位点有6例(4.4%),E157Q是主要的耐药突变位点,埃替拉韦和拉替拉韦是主要的耐药药物;有1例(0.7%)同时出现NNRTI和INSTI耐药突变位点。经过单因素和多因素logistic回归分析,相较于年龄>30岁,年龄≤30岁发生TDR风险更高。结论凉山州某县未接受ART的HIV-1感染者的耐药情况不容忽视,相较于年龄>30岁,年龄≤30岁发生TDR风险更高,建议HIV-1感染者在接受ART前均进行HIV-1耐药检测。
Objective To analyze the prevalence of transmitted drug resistance(TDR)among HIV-1 treatment-naïve patients in a county of Liangshan Prefecture for better understanding local spread of resistant HIV-1 strains and proposing appropriate antiretroviral therapy(ART)regimen.Methods ART treatment-naïve HIV-1 patients were identified and included in this analysis in a county of Liangshan Prefecture from January 2022 to August 2022.Blood samples were collected to prepare plasma samples for quantitative detection and resistance genotyping of HIV-1 RNA.Blood cell samples were used for quantitative detection and resistance genotyping of HIV-1 DNA.Results Overall,135 patients were enrolled,including 75 males(55.6%)and 60 females(44.4%),with a median age of 37.5 years.Majority of the patients(96.3%)were Yi nationality.Sexual transmission was the main pathway of HIV-1 transmission,accounting for 83.0%.TDR was identified in 11 of the 135 patients.The overall prevalence of TDR was 8.1%.The median time from diagnosis of HIV-1 infection to drug resistance testing was 11 days.HIV-1 RNA was 10001-100000 copies/mL in 43.7%of the patients.HIV-1 DNA was 101-1000 copies/106 cells in 55.6%of the patients.Subtype B+C recombinants were the most prevalent HIV-1 subtype(51.9%),followed by CRF07_BC recombinants(43.0%).Drug resistance mutation site was identified in 23(17.0%)of the 135 patients,specifically,resistance to nonnucleoside reverse transcriptase inhibitors(NNRTIs),mainly efavirenz and or nevirapine,primarily conferred by K103N mutation in 16(11.9%)patients;resistance to integrase inhibitors(INSTIs),mainly,elvitegravir and raltegravir,primarily conferred by E157Q mutation in 6(4.4%)patients;and resistance to both NNRTIs and INSTIs in 1(0.7%)patient.Univariate and multivariate logistic regression analyses demonstrated that young patients(≤30 years of age)had higher risk of TDR compared with older patients(age>30 years of age).Conclusions The clinicians should be aware of the TDR among HIV-1 treatment-naïve patients in a county of
作者
刘梅
朱芮
吴涛
俄尔阿沙木
袁天茹
宋绍芳
刘玲
梁洪远
曹汴川
LIU Mei;ZHU Rui;WU Tao;E’ER Ashamu;YUAN Tianru;SONG Shaofang;LIU Ling;LIANG Hongyuan;CAO Bianchuan(Antiviral Therapy Center,the First People's Hospital of Yuexi County,Liangshan Sichuan 616650,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2024年第1期19-24,共6页
Chinese Journal of Infection and Chemotherapy
基金
中国性病艾滋病防治协会·妇幼泰格关爱及预防母婴传播基金(PMTCT202207)。
