摘要目的 了解我国部分地区HIV-1感染者原发性耐药基因突变的发生情况及亚型分布.方法 收集浙江、上海、河南及安徽未经治疗的HIV-1感染者的血浆样本88份,采用反转录聚合酶链反应扩增pol基因片段,进行序列测定以及耐药性突变分析,并应用PHYLIP等软件构建进化树.应用SPSS 13.0软件进行统计分析,两样本构成比的比较采用Fisher's精确检验.结果 共获得79份HIV-1分离株的pol基因序列,亚型分析表明,54例(68.4％)为B亚型,22例(24.8％)为CRF01 _AE重组体,另有2例(2.5％) CRF07_BC重组体和1例(1.3％) CRF08_BC重组体.在7例(7/79,8.9％)样本中发现了有关抗反转录病毒药物的主要耐药性突变,其中3例( 3/79,3.8％)为核苷类反转录酶抑制剂(NRTIs)耐药性突变,4例(4/79,5.1％)为非核苷类反转录酶抑制剂(NNRTIs)耐药性突变;所有样本均未发现对蛋白酶类(Pis)药物的主要耐药性突变.结论 慢性HIV-1感染者原发性耐药发生的概率仍较低,初次治疗前的耐药性检测并非必需.

abstractsObjective To investigate the prevalence of drug-resistant mutations in reverse transcriptase and protease coding regions of HIV-1 in treatment-na(i)ve patients. Methods Plasma specimens were collected from 88 patients from Zhejiang, Shanghai, Henan and Anhui. The entire protease gene and the first 1-251 amino acids of the reverse transcriptase gene were amplified by RT-PCR from viral RNA and sequenced. The sequences were analyzed with HIV drug resistance algorithm, and phyligenetic analyses were performed by PHYLIP software. SPSS 13.0 was used for statistical analysis, and Fisher' s exact test was performed to compare the proportions of each subtype between the groups. Results 79 gene sequences were obtained, subtyping analyses indicated that 68.4％ (54/79) were subtype B, followed by CRF01 _AE 24.8％ (22/79), CRF07_BC 2.5％ (2/79), and CRF08_BC 1.3％ (1/79). 7 (7/79, 8.9％)presented with primary mutations associated with resistance to antiretroviral drugs, mutations conferring primary resistance to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors ( NNRTIs ) were detected in 3 ( 3. 8％ ) and 4 ( 5. 1％ ) cases, respectively. Protease inhibitors (Pls) associated primary resistance mutations were not found. Conclusion Antiretroviral drug resistant mutations have been found in treatment-na(i)ve patients with HIV-1 infections, while the prevalence level is low, which indicates that drug resistance test is not necessary for most HIV-1infected treatment-na(i)ve patients.