摘要目的:了解杭州市新报告HIV感染者/艾滋病患者(HIV/AIDS)抗逆转录病毒治疗(ART)前HIV-1亚型流行特征及耐药情况。方法:收集杭州市2020—2022年新确证且未经抗病毒治疗的HIV/AIDS病例血样，扩增HIV-1 pol区基因并测序。使用MEGA7.0软件构建系统进化树判断亚型，提交序列至斯坦福大学耐药数据库，确定耐药突变位点及毒株对药物的敏感性。 结果:获得2 700条 pol基因序列，发现12种HIV-1亚型，以CRF07_BC (46.8%，1 263/2 700)和CRF01_AE (34.6%，933/2 700)为主。ART前HIV-1耐药率8.1%(220/2 700)，其中，蛋白酶抑制剂(PIs)、核苷类反转录酶抑制剂(NRTIs)和非核苷类反转录酶抑制剂(NNRTIs)耐药率分别为2.8%(75/2 700)、1.3%(36/2 700)和4.4%(119/2 700)。220例耐药病例中，PIs耐药突变位点为Q58E(21.4%，47/220)，NRTIs耐药突变位点为M184V/I(5.9%，13/220)，NNRTIs耐药突变位点为K103N/S(19.1%，42/220)和E138A/G/K/Q(18.6%，41/220)。 结论:2020—2022年杭州市新报告HIV/AIDS病例中HIV-1基因型高度复杂，ART前耐药达到中度流行水平，发现对骨干药物中度及高度耐药病例，应加强监测，避免治疗失败并减少耐药株的传播。

abstractsObjective:To analyze the HIV-1 subtypes and drug resistance among newly reported HIV/AIDS cases before antiretroviral therapy (ART) in Hangzhou.Methods:Blood samples were collected from newly diagnosed HIV-1/AIDS cases not receiving ART in Hangzhou from 2020 to 2022. HIV-1 pol gene was amplified and then sequenced. A phylogenetic tree was construct using MEGA7.0 software to analyse the HIV-1 subtypes, The sequences were submitted to the Stanford University drug resistance database to identify drug resistance mutation sites and drug sensitivity. Results:A total of 2 700 sequences were obtained. Twelve subtypes were identified, and the predominant subtypes were CRF07_BC (46.8%, 1 263/2 700) and CRF01_AE (34.6%, 933/2 700). The overall drug resistance rate before ART was 8.1% (220/2 700) and the resistance rates to protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) were 2.8% (75/2 700), 1.3% (36/2 700) and 4.4% (119/2 700), respectively. Among the 220 drug-resistant cases, mutations conferring resistance to PIs (Q58E), NRTIs (M184V/I) and NNRTIs (K103N/S and E138A/G/K/Q) were detected in 47 (21.4%), 13 (5.9%), 42 (19.1%) and 41 (18.6%) patients, respectively.Conclusions:HIV-1 genotypes were highly complex in newly reported HIV/AIDS cases in Hangzhou from 2020 to 2022. There were cases showing moderate or high resistance to backbone drugs before ART, indicating that HIV-1 monitoring should be strengthened to avoid treatment failure and reduce the spread of drug-resistant strains.