广州市2008-2015年未接受抗病毒治疗的男男性行为人群艾滋病病毒感染者耐药分析

韩志刚; 张亚丽; 吴昊; 高凯; 赵宇腾; 古羽舟; 陈韵聪

Abstract

韩志刚,张亚丽,吴昊,高凯,赵宇腾,古羽舟,陈韵聪.广州市2008-2015年未接受抗病毒治疗的男男性行为人群艾滋病病毒感染者耐药分析[J].Chinese journal of Epidemiology,2018,39(7):977-982

广州市2008-2015年未接受抗病毒治疗的男男性行为人群艾滋病病毒感染者耐药分析

Prevalence of drug resistance in treatment-naive HIV infected men who have sex with men in Guangzhou, 2008-2015

Received:October 14, 2017

DOI：10.3760/cma.j.issn.0254-6450.2018.07.021

KeyWord: 艾滋病病毒男男性行为人群耐药

English Key Word: HIV Men who have sex with men Drug resistance

FundProject:广州市科技计划项目（201707010184，201704020219）

Author Name	Affiliation	E-mail
Han Zhigang	Department of Operational Control, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China	zhiganghan616@163.com
Zhang Yali	School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China
Wu Hao	Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
Gao Kai	Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
Zhao Yuteng	Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
Gu Yuzhou	Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
Chen Yuncong	Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China

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Abstract:

目的了解广州市未接受抗病毒治疗的MSM人群HIV感染者（MSM感染者）耐药株流行状况。方法收集2008－2015年新确证HIV-1抗体阳性、现住址为广州市、传播途径为男男性行为传播、确证时未接受过抗病毒治疗的MSM感染者血清样本，提取HIV-1 RNA，采用巢式PCR法扩增HIV-1 pol区全部蛋白酶（PR）和部分反转录酶（RT）基因片段，测序后提交到美国斯坦福大学HIV耐药数据库进行耐药分析。结果 2 283例MSM感染者中，共有1 986例血清样本成功获得pol区基因片段，年龄16～84（30.18±8.24）岁；未婚者占74.17%（1 473/1 986）；汉族占90.64%（1 800/1 986）；大专及以上占49.65%（986/1 986），高中及中专占27.14%（539/1 986），初中及以下占20.89%（415/1 986）。HIV-1亚型以CRF07_BC和CRF01_AE为主，分别为38.22%（759/1 986）和34.49%（685/1 986）。总耐药率为3.32%（66/1 986），对蛋白酶抑制剂（PIs）耐药率为1.36%（27/1 986）），对核苷类反转录酶抑制剂（NRTIs）耐药率为0.65%（13/1 986），对非核苷类反转录酶抑制剂（NNRTIs）耐药率为1.61%（32/1 986）。B亚型对3类药物的耐药率均较高，CRF55_01B对NNRTIs耐药率高于其他亚型。B亚型对司他夫定（D4T）、依非韦仑（EFV）、奈韦拉平（NVP）的耐药率最高，均为4.17%（5/120）；其次是那非那韦（NFV）、齐多夫定（AZT）、利匹韦林（RPV），均为3.33%（4/120）。CRF55_01B对EFV、NVP的耐药率最高，均为5.50%（16/291）；其次是依曲韦林（ETR）、RPV，均为5.15%（15/291）。结论广州市未接受抗病毒治疗的MSM感染者耐药率处于低水平，现有抗病毒药物在总体上仍是有效的。但B亚型和CRF55_01B亚型耐药率相对较高，值得关注。

English Abstract:

Objective To understand the prevalence of drug resistance in treatment-naive HIV infected men who have sex with (MSM) in Guangzhou. Methods HIV-1 RNA were extracted from the serum specimens of the MSM newly confirmed to be HIV-1 positive, living in Guangzhou and receiving no anti-viral therapy from 2008 to 2015. HIV-1 pol gene segments, including full protease and part reverse transcriptase, were amplified by nested reverse transcription polymerase chain reaction (nested-PCR) and sequenced by Sanger. Subsequently, the sequence data were submitted to Stanford University HIV Drug Resistance Database for drug resistance analysis. Results Among 2 283 HIV infected MSM, HIV-1 pol gene segments were obtained from the serum samples of 1 986 HIV infected MSM aged 16-84 (30.18±8.24) years. Among them, the unmarried accounted for 74.17% (1 473/1 986), those of Han ethnic group accounted for 90.64% (1 800/1 986), those with education level of college or above accounted for 49.65% (986/1 986), those with education level of senior high school or secondary school accounted for 27.14% (539/1 986), those with education level of junior high school or below accounted for 20.89% (415/1 986). The distribution of subtypes was predominated by CRF07_BC (38.22%, 759/1 986) and CRF01_AE (34.49%, 685/1 986). The overall prevalence of drug resistance was 3.32% (66/1 986). The prevalence of resistance to protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) were 1.36%(27/1 986), 0.65% (13/1 986) and 1.61% (32/1 986), respectively. Subtype B had higher resistance to PIs, NRTIs and NNRTIs and subtype CRF55_01B had highest resistance to NNRTIs compared with other subtypes. In subtype B, the resistant rates to D4T, EFV and NVP were highest (all 4.17%, 5/120), followed by those to NFV, AZT and RPV (all 3.33%, 4/120). In subtype CRF55_01B, the resistant rates to EFV and NVP were highest (all 5.50%, 16/291),followed by those to ETR and RPV (all 5.15%, 15/291). Conclusions The prevalence of drug resistance in treatment-naive HIV infected MSM in Guangzhou remained at low level and current antiretroviral drugs are generally effective. However, subtype B and CRF55_01B have higher drug resistance.

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