摘要目的 了解江阴市2013-2015年常住人口中新发HIV-1感染者亚型分布及原发耐药基因变异情况.方法 选取江阴市疾病预防控制中心2013-2015年确认和管理的111例常住人口新发HIV-1感染者为研究对象,收集其抗凝全血标本,提取DNA并扩增HIV病毒pol区部分基因,通过系统进化树判断患者亚型;根据WHO耐药突变位点列表及美国斯坦福大学HIV耐药数据库,确定耐药基因突变位点及耐药程度.结果 111例样本中,pol区成功扩增并测序100例,系统进化树结果确定江阴市HIV-1流行毒株分属7种亚型和重组型,以CRF01 _AE (44/100)、CRF07_BC (21/100)以及CRF67_01B(14/100)亚型为主.耐药位点检测结果显示,14例患者体内存在原发耐药基因突变位点,原发耐药率为14.0％ (14/100),核苷类反转录酶抑制剂(NRTIs)、非核苷类反转录酶抑制剂(NNRTIs)以及蛋白酶抑制剂(PIs)耐药突变率分别为3.0％、7.0％、6.0％.2～4年随访调查结果显示,14例基因型耐药患者有9例患者在治疗过程中发生了临床耐药,耐药率为8.1％ (9/111),其中5例患者为CRF01_AE亚型.结论 2013-2015年常住人口中新发HIV-1感染者亚型分布呈现多样性,且存在一定比例的原发耐药基因突变;新发HIV感染者在接受抗病毒治疗前进行耐药基因检测,并制定合理的抗病毒治疗方案,可减少耐药株的产生.

abstractsObjective To investigate the subtypes and primary drug resistant (PDR)mutations among HIV-1 infected population in Jiangyin.Methods Anticoagulated blood samples were collected from HIV infected individuals confirmed and managed by Jiangyin CDC from 2013-2015,and epidemiological data were analyzed.The pol gene was amplified by nested-PCR from the DNA extraction and then sequenced.Phylogenetic tree was constructed to determine the subtypes of the samples.PDR mutations and viral susceptibility to ARTs were interpreted with the Surveillance Drug Resistance Mutations (SDRM)list recommended by WHO and Stanford University HIV Drug Resistance database.Results The pol gene of 100 cases was successfully amplified and sequenced among 111 samples enrolled in this study,7 different subtypes were found by phylogenetic tree analysis and CRF01_AE (44/100),CRF07_BC (21/100),CRF67 _01B (14/100)subtypes accounted for the main part.Fourteen participants (14/100)met the WHO guidelines of having HIV-1 PDR.NRTI,NNRTI,PI PDR mutation rates were 3.0％,7.0％,and 6.0％,respectively.Nine cases of the 14 infections with PDR presented clinical DR and the resistance rate was 8.1％,of which CRF01_AE accounted for the main part (5/9).Conclusions The prevalence of HIV-1 infections of different subtypes in Jiangyin city varied and there was a certain proportion of primary drug resistance.Corresponding drug resistance testing should be carried out for new HIV infections before treatment and reasonable antiviral treatment plan should be formulated,which will reduce the emergence of drug-resistant strains ultimately.