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上海市浦东新区中青年感染人群HIV-1分子流行特征及耐药情况分析

Molecular epidemiologic characteristics and pretreatment drug resistance of HIV-1 in young and middle-aged first-diagnosed infections, 2019–2021 in Pudong New Area, Shanghai

  • 摘要:
    目的 了解上海市浦东新区2019—2021年<50岁的中青年人群中未经抗病毒治疗的新确诊感染者/患者HIV-1分子流行病学特征及耐药情况,为艾滋病防治策略提供参考依据。
    方法 收集2019—2021年浦东新区确诊实验室HIV-1抗体首次确诊阳性且人口学信息满足条件的347份<50岁人群血样本,采用反转录聚合酶链式反应(RT-PCR)扩增HIV-pol基因,进行治疗前耐药基因检测及 HIV-1亚型检测。
    结果 获取302例HIV-pol区基因全序列片段,HIV-1流行簇主要有CRF07_BC(40.40%)、CRF01_AE(36.09%)、CRF55_01B(8.28%);感染途径为同性性传播(72.52%)和异性性传播(27.48%);不同性传播途径的病毒亚型分布差异有统计学意义(P=0.003)。HIV-1耐药率为5.96%,低中高度耐药均有出现,其中NNRTIs、NRTIs、PIs分别为4.97%、0.66%、0.33%;不同亚型之间的耐药率差异有统计学意义(P=0.037)。
    结论 上海市浦东新区2019—2021年中青年人群新确诊HIV-1感染者,基因亚型主要以CRF07_BC、CRF01_AE 、CRF55_01B为主,但已出现新的重组毒株,呈现多元化发展趋势,且在多种亚型中出现不同程度的治疗前耐药。

     

    Abstract:
    Objective To investigate the molecular epidemiological characteristics and drug resistance of HIV-1 among newly diagnosed antiretroviral therapy (ART)-naive infected individuals aged < 50 years in Pudong New Area, Shanghai, 2019–2021, and to provide evidence to refine local HIV prevention and control strategies.
    Methods Blood samples (n=374) were collected from individuals newly diagnosed with HIV infection between 2019 and 2021. Inclusion criteria were as follows: (1) confirmed first-time HIV-positive diagnosis by Western blot and without prior ART, (2) age less than 50 years, (3) voluntary participation, and (4) current residence or employment in Pudong New Area. Exclusion criteria were: (1) unsuccessful RNA extraction or sequencing, (2) mixed bases in the HIV-pol region sequence ≥5%, and (3) sequences shorter than 1 000 base pairs. The HIV-1 pol gene was amplified by reverse transcription-polymerase chain reaction (RT-PCR) for both pretreatment drug resistance genotyping and HIV-1 subtype determination, with subsequent analysis using the Stanford University HIV Drug Resistance Database for 302 successfully sequenced samples. Demographic and epidemiologic data were collected through structured in-person interviews.
    Results A total of 13 HIV-1 subtypes and unique recombinant forms (URFs) were identified among the 302 sequenced samples, of which 72.52% were from homosexual and 27.48% from heterosexual infections. The predominant strains were CRF07_BC (40.40%), CRF01_AE (36.09%) and CRF55_01B (8.28%). A significant variance in the distribution of viral subtypes was observed among individuals infected by different sexual transmission routes (χ2=22.161, P=0.003). However, the distribution of the prevalent strains CRF01_AE, CRF07_BC and CRF55_01B did not differ significantly between homosexual and heterosexual transmission (χ2=4.854, P=0.088), nor among the three age groups 15–24, 25–34 and 35–49 years (χ2=1.383, P=0.847). Resistance analysis showed a resistance rate of 5.96% in this population, with resistance levels ranging from low to intermediate to high. Non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs) and protein inhibitors (PIs) accounted for 4.97%, 0.66% and 0.33% of resistance, respectively. The difference in resistance rates between subtypes was statistically significant (χ2=10.511, P=0.037). All cases (n=25) of the recombinant subtype CRF55_01BC had mutations at the resistance locus, resulting in an 88.00% incidence of mutations at potential resistance loci and a 12.00% incidence of resistance associated with moderate to high levels of resistance.
    Conclusions From 2019 to 2021, among the newly diagnosed HIV-1 infected individuals of young and middle-aged population in Pudong New Area, Shanghai, the genetic subtypes were predominantly CRF07_BC, CRF01_AE and CRF55_01B. However, new recombinant strains have emerged, indicating a trend toward diversification. In addition, varying degrees of pre-treatment drug resistance were observed in several subtypes.

     

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