广州市2008-2015年未接受抗病毒治疗的注射吸毒人群HIV-1感染者耐药分析

徐理倩; 韩志刚; 张亚丽; 吴昊; 高凯; 黎庆梅; 徐慧芳; 蔡衍珊; 夏云

Abstract

徐理倩,韩志刚,张亚丽,吴昊,高凯,黎庆梅,徐慧芳,蔡衍珊,夏云.广州市2008-2015年未接受抗病毒治疗的注射吸毒人群HIV-1感染者耐药分析[J].Chinese journal of Epidemiology,2019,40(2):196-201

广州市2008-2015年未接受抗病毒治疗的注射吸毒人群HIV-1感染者耐药分析

Prevalence of antiretroviral drug resistance in treatment-naive injecting drug users infected with HIV-1 in Guangzhou, 2008-2015

Received:July 25, 2018

DOI：10.3760/cma.j.issn.0254-6450.2019.02.014

KeyWord: 艾滋病病毒注射吸毒人群耐药

English Key Word: HIV Injecting drug user Drug resistance

FundProject:广州市科技计划项目（201707010184）

Author Name	Affiliation	E-mail
Xu Liqian	School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China
Han Zhigang	Department of Operational Control, Guangzhou Municipal Center for Disease Control and Prevention, Guangzhou 510440, China
Zhang Yali	School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China
Wu Hao	Department of AIDS Control and Prevention, Guangzhou Municipal Center for Disease Control and Prevention, Guangzhou 510440, China
Gao Kai	Department of AIDS Control and Prevention, Guangzhou Municipal Center for Disease Control and Prevention, Guangzhou 510440, China
Li Qingmei	Department of AIDS Control and Prevention, Guangzhou Municipal Center for Disease Control and Prevention, Guangzhou 510440, China
Xu Huifang	Department of AIDS Control and Prevention, Guangzhou Municipal Center for Disease Control and Prevention, Guangzhou 510440, China
Cai Yanshan	Department of AIDS Control and Prevention, Guangzhou Municipal Center for Disease Control and Prevention, Guangzhou 510440, China
Xia Yun	School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China	592481407@qq.com

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Abstract:

目的了解广州市未接受抗病毒治疗的注射吸毒人群（IDU）HIV-1感染者耐药株流行情况。方法收集2008-2015年新确证HIV-1抗体阳性、现住址为广州市、传播途径为注射吸毒、确证时未接受抗病毒治疗的IDU HIV-1感染者的血清样本，提取HIV-1 RNA，采用巢式PCR法扩增pol区蛋白酶（PR）基因全序列与反转录酶（RT）基因部分序列并测序后，提交到美国斯坦福大学HIV耐药数据库做耐药分析。结果 518例HIV感染者中，有407例（78.57%）血清样本成功获得pol区基因片段。年龄18~64（37.44±8.14）岁，男性占89.68%（365/407），汉族占89.93%（366/407），未婚者占55.28%（225/407），文化程度以初中及以下为主（83.78%，341/407）。HIV-1亚型以CRF07_BC为主（47.18%，192/407），CRF01_AE占23.83%（97/407）和CRF08_BC占22.85%（93/407），其他亚型占6.14%（25/407）。总耐药率为3.44%（14/407），蛋白酶抑制剂耐药率为1.47%（6/407），核苷类反转录酶抑制剂耐药率为0.25%（1/407），非核苷类反转录酶抑制剂耐药率为1.72%（7/407）。突变发生率为12.29%（50/407），蛋白酶区和核苷类反转录酶区未检出主要耐药突变，非核苷类反转录酶区中V179E突变率更高的是其他亚型和CRF07_BC亚型，其他亚型中的CRF55_01B亚型8例全部发生此突变；E138A突变率最高的是CRF08_BC亚型，为3.23%。有2例病例对NNRTIs的4种药物全都耐药。结论 2008-2015年广州市未接受抗病毒治疗的IDU HIV-1感染者的耐药率处于较低水平，大多数IDU HIV-1感染者对现有抗病毒治疗药物敏感。应加强IDU HIV-1感染者的耐药监测，控制耐药性毒株多重、交叉耐药的流行。

English Abstract:

Objective To understand the prevalence of drug resistance in treatment-naive injecting drug users (IDUs) infected with HIV-1 in Guangzhou. Methods HIV-1 RNA were extracted from the serum specimens of the newly confirmed HIV-1 positive IDUs living in Guangzhou, being infected through injecting drug use and receiving no antiretroviral therapy at the time of confirmation during 2008-2015. Full sequence of pol protease (PR) gene and partial sequence of reverse transcriptase (RT) gene were amplified by nested reverse transcription polymerase chain reaction (nested-PCR) and sequenced. After that, data were submitted to the HIV resistance database of Stanford University for drug resistance analysis. Results Among the 518 HIV-1 infected IDUs, HIV-1 pol gene segments were successfully obtained from the serum samples of 407 HIV-1 infected IDUs (78.57%) aged 18-64 (37.44±8.14) years. Among them, males accounted for 89.68% (365/407), those of Han ethnic group accounted for 89.93% (366/407), the unmarried accounted for 55.28% (225/407), and those with education level of junior high school or below accounted for 83.78% (341/407). The distribution of subtypes was predominated by CRF07_BC (47.18%, 192/407), followed by CRF01_AE (23.83%, 97/407), CRF08_BC (22.85%, 93/407), and other subtypes (6.14%, 25/407). The overall prevalence of drug resistance was 3.44% (14/407). The prevalence of drug resistance to protease inhibitors, nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors were 1.47%(6/407), 0.25% (1/407) and 1.72% (7/407) respectively. The mutation rate was 12.29% (50/407). No major drug resistance mutation was detected in protease and nucleoside reverse transcriptase regions. Higher rate of V179E mutation in the non-nucleoside reverse transcriptase region was detected in other subtypes and subtype CRF07_BC. Mutation seemed to have occurred in all 8 cases of subtype CRF55_01B in other subtypes. The highest mutation rate of E138A was detected in subtype CRF08_BC (3.23%). Two cases were resistant to all four drugs of NNRTIs. Conclusions The prevalence of drug resistance in treatment-naive HIV-1 positive IDUs remained at a relatively low level during 2008-2015, in Guangzhou. Most infections were sensitive to existing antiviral drugs. However, drug resistance surveillance in IDUs infected with HIV should be strengthened to prevent the prevalence of multi-drug resistance and cross drug resistance.

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