摘要
目的探究接受抗病毒治疗的HIV/AIDS低病毒血症患者耐药情况和影响因素,基因亚型与耐药位点突变情况。方法纳入病毒载量50-999copies/mL的HIV/AIDS患者,巢式PCR扩增HIV-1的pol基因后进行耐药检测,根据世界卫生组织耐药标准和斯坦福大学耐药数据库判定耐药、确定突变位点以及毒株对ART药物的敏感性,Logistic回归分析耐药影响因素。结果896例低病毒血症患者中65.6%(588例)pol基因扩增成功。总耐药率为24.7%(145/588),NNRITs耐药率最高,为21.3%(125/588),部分患者存在多重耐药。588例HIV/AIDS低病毒血症患者中HIV-1毒株BC重组亚型占25.2%(148人),B亚型占24.5%(144人),C亚型占23.5%(138人),CRF 01_AE亚型占14.3%(84人)。Logistic回归分析发现,耐药与HIV-1病毒亚型有关。B亚型耐药率最高,为43.1%(62/144),CRFs、C亚型、URFs耐药率分别为22.7%(32/141)、18.8%(26/138)、15.2%(25/165)。所有亚型中K103 N、M184V/I突变频率最高,分别产生了对EFV/NVP、3TC/FTC的高度耐药。结论德宏州接受ART的HIV/AIDS低病毒血症患者耐药较为常见,不同毒株基因亚型耐药率不同,出现了常见的几种耐药突变,并产生对NNRTIs和NRTIs的耐药。应及时监测该人群的耐药情况,为更换ART药物、改善预后提供依据。
Objective To investigate drug resistance and its influencing factors,including genetic subtypes and drug resistance-related mutations,among people living with HIV(PLWH)who developed low-level viremia(LLV)and were receiving antiretroviral therapy(ART).Methods PLWH with a viral load between 50–999 copies/mL were included,and the pol gene of HIV-1 was amplified using nested polymerase chain reaction(PCR)for drug resistance testing.Drug resistance was determined according to the drug resistance standards of the World Health Organization and the Stanford University HIV drug resistance database.Moreover,mutation sites were identified,and the sensitivity of each strain to ART drugs was determined.Logistic regression was performed to analyze the factors influencing drug resistance.Results Among 896 patients with LLV,amplification of the pol gene was successful in 65.6%(n=588)patients.The overall drug resistance rate was 24.7%(145/588).The highest resistance rate was seen against non-nucleoside reverse transcriptase inhibitors(NNRITs)at 21.3%(125/588).Moreover,some patients developed multiple drug resistance.Among 588 HIV/AIDS patients with LLV,the BC recombinant subtype accounted for 25.2%(148/588),subtype B accounted for 24.5%(144/588),subtype C accounted for 23.5%(138/588),and subtype CRF01_AE accounted for 14.3%(84/588).Logistic regression analysis showed that drug resistance was related to HIV-1 subtypes.The highest drug resistance rate was seen for subtype B at 43.1%(62/144),while drug resistance rates of CRFs,subtype C,and unique recombinant forms(URFs)were 22.7%(32/141),18.8%(26/138),and 15.2%(25/165),respectively.Among all subtypes,the highest mutation rates were seen for K103 N and M184V/I mutations,which resulted in high resistance to Efavirenz/Nevirapine and Lamivudine/Emtricitabine.Conclusions Drug resistance is common among PLWH with LLV who received ART in Dehong Prefecture.Different gene subtypes were associated with different resistance rates.Several common drug-resistant mutations have emerged,which resulted in resistance to NNRTIs and NRTIs.It is necessary to monitor drug resistance tinely among this population to provide a basis for changing ART drugs and improving prognosis.
作者
段星
陈泰霖
王继宝
曹东冬
杨涛
周素娟
王译葵
杨锦
杨跃诚
唐仁海
叶润华
丁盈盈
何纳
段松
DUAN Xing;CHEN Tailin;WANG Jibao;CAO Dongdong;YANG Tao;ZHOU Sujuan;WANG Yikui;YANG Jin;YANG Yuecheng;TANG Renhai;YE Runhua;DING Yingying;HE Na;DUAN Song(Department for STD&AIDS Control and Prevention,Dehong Autonomous Prefecture Center for Disease Control and Prevention,Mangshi 678400,Yunnan,China;Department of Epidemiology,School of Public Health,Key Laboratory of Public Health Safety of the Ministry of Education,Fudan University,Shanghai 200032,China;People's Hospital of Dehong Autonomous Prefecture,Mangshi 678400,Yunnan,China)
出处
《中国艾滋病性病》
CAS
CSCD
北大核心
2023年第10期1074-1080,共7页
Chinese Journal of Aids & STD
基金
国家科技重大专项(2018ZX10721102-004,2018ZX10715006-001)
国家重点地区艾滋病防治项目(卫办疾控发[2004]49号)。
关键词
艾滋病病毒
低病毒血症
耐药
基因亚型
human immunodeficiency virus(HIV)
low-level viremia(LLV)
drug resistance
subtype
