摘要目的 调查分析宁夏地区接受抗病毒治疗的艾滋病病人HIV病毒基因亚型和耐药突变流行情况,指导抗病毒药物的选择.方法 收集宁夏地区接受抗病毒治疗的人群中HIV-1感染者的血浆,采用逆转录聚合酶链反应(RT-PCR)和套式聚合酶链反应(Nested-PCR)方法,扩增蛋白酶(PR)基因区和反转录酶(RT)基因区,并对扩增片断进行序列测定和分析,用Mega等软件构建进化树、亚型及耐药研究.结果 共获得17例HIV-1完整的PR和RT基因序列,10例产生15个耐药位点致使7例AIDS耐药,总耐药率为8.3％,其中1份样本产生了核苷类抑制剂(NRTI)和非核苷类抑制剂(NNRTI)耐药性突变,1份样本产生蛋白酶抑制剂(PI)主要耐药突变,4份样本产生PI次要耐药突变;1份样本产生了NRTI耐药性突变,5份样本产生了NNRTI耐药性突变.非核苷类耐药性突变、核苷类耐药性突变和PI次要耐药突变位点分别以V179E、Y181C、V179D、K101E、G190A和M46LM、L10LV、A71 AT为主.结论 宁夏已经出现了针对蛋白酶抑制剂耐药的毒株、核苷类抑制剂和非核苷类抑制剂双重耐药的毒株,有必要对未进行抗病毒治疗的感染者进行耐药监测.

abstractsObjective To investigate HIV virus subtypes and drug resistance mutations in AIDS patients in order to guide the choice of antiviral drugs.Methods Collection plasma from the AIDS patients in Ningxia who received antiretroviral treatment.The protease (PR) gene region and reverse transcriptase (RT) gene region were amplified by reverse transcription polymerase chain reaction (RT-PCR) and nested polymerase chain reaction (Nested-PCR),and the amplified fragments were sequenced and analyzed to study on the phylogenetic tree,subtype and drug resistance.Results The gene whole sequence of HIV-1 PR and RT were obtained from 17 cases,15 resistance loci were found in 10 cases,which caused the drug-resistan tin 7 cases,the drug resistance rate was 8.3％,the nucleoside inhibitors (NRTI) and non-nucleoside inhibitors (NNRTI) resistance mutations was found in 1 sample,a primary protease inhibitor (PI) resistance mutations was found in 1 sample,the secondary PI resistance mutations were found in 4 samples; the NRTI resistance potency mutation was found in 1 sample,the NNRTI resistance mutations were found in 5 samples.Non-nucleoside resistance mutations,nucleoside resistance mutations and secondary PI resistance mutations were mainly caused by V179E,Y181C,V179D,K101E,G190A and M46LM,L10LV,A71AT.Conclusions The protease inhibitors of drug resistance strain,nucleoside inhibitors and non-nucleoside inhibitors double drug-resistant strains has emerged in Ningxia,it is necessary to study on the patients without antiviral treatment for drug resistance.