Analysis on the epidemiological characteristics and transmitted drug resistance of MSM HIV infected individuals in Longgang District, Shenzhen City
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摘要:
目的 了解深圳市龙岗区男男性接触者(men who have sex with men, MSM)、HIV感染者的流行病学特征及耐药株流行情况,为制定本区MSM、HIV感染者防控策略提供参考依据。 方法 收集2016―2018年本辖区新报告的MSM HIV感染者的外周静脉血血浆,提取病毒RNA,对HIV-1 pol区基因片段进行扩增并测序,采用MEGA 6.0软件构建系统进化树确定基因亚型,并以斯坦福大学HIV耐药数据库进行耐药分析。 结果 从148例病例样本中成功扩增119份,其亚型分布包括CRF07_BC(45.38%, 54/119)、CRF01_AE (28.57%, 34/119)、CRF55_01B (25.21%, 30/119)和B亚型(0.84%, 1/119)。2016―2018年深圳市龙岗区MSM HIV/AIDS患者抗病毒治疗前HIV-1耐药株流行率为4.20%(5/119), 对核苷类反转录酶抑制剂(nucleoside reverse transcriptase inhibitors, NRTIs)耐药率最高为2.52%(3/119)。总体耐药突变率为31.1%(37/119),CRF55_01B亚型感染者均出现耐非核苷类反转录酶抑制剂(non-nucleoside reverse transcriptase inhibitors, NNRTIs)的V179E突变。 结论 2016―2018年龙岗区新增确证的MSM HIV感染者处于低耐药水平。需进一步关注V179D/E突变对临床一线药物治疗CRF55_01B亚型感染者疗效的影响。 Abstract:Objective To understand the epidemiological characteristics of HIV infected individuals and the prevalence of drug-resistant strains among men who have sex with men (MSM) in Longgang District of Shenzhen City, so as to provide guidance for the development of MSM HIV infected individuals prevention and control policy. Methods Perioheral venous blood plasma of newly reported MSM HIV infected individuals were collected in Longgang District of Shenzhen City from 2016 to 2018. After extracting viral RNA, the HIV-1 pol region gene fragments were amplified and sequenced. The phylogenetic tree was constructed by the MEGA 6.0 software for HIV genotype determination. Drug resistance was analyzed by using the Stanford University's HIV drug resistance database. Results A total of 119 among 148 samples were successfully amplified, including subtypes of CRF07_BC (45.38%, 54/119), CRF01_AE (28.57%, 34/119), CRF55_01B (25.21%, 30/119) and B subtype (0.84%, 1/119). The prevalence rate of HIV-1 drug-resistant strains in MSM HIV infected individuals in Longgang District before antiviral treatment was 4.20% (5/119), and the drug-resistant rate to nucleoside reverse transcriptase inhibitors (NRTIs) was the highest 2.52% (3/119) during 2016 to 2018. The overall drug resistance mutation rate was 31.1% (37/119). All patients infected with CRF55_01B subtype had V179E mutation resistant to non-nucleoside reverse transcriptase inhibitors (NNRTIs). Conclusion The newly confirmed MSM HIV infected individuals in Longgang District from 2016 to 2018 is at a low drug resistance level. Further attention should be paid to the effect of V179D/E mutation on the efficacy of clinical first-line drugs in the treatment of patients with CRF55_01B subtype infection. -
Key words:
- Epidemiological characteristics /
- MSM /
- Resistance analysis
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表 1 深圳市龙岗区新报告的MSM HIV感染者基本情况分析
Table 1. The essential characteristic analysis of newly reported MSM HIV infected individuals in Longgang District of Shenzhen City
人群特征 2016年(n=35) 2017年(n=48) 2018年(n=36) 合计[n(%)] H/Z值 P值 例数 构成比(%) 例数 构成比(%) 例数 构成比(%) 年龄组(岁) 6.405 0.174 < 25 7 33.33 5 23.81 9 42.86 21(17.65) 25~ < 30 9 28.13 18 56.25 5 15.63 32(26.89) 30~ < 40 8 22.86 14 29.17 16 44.44 38(31.93) 40~ < 50 7 20.00 9 18.75 5 13.89 21(17.65) ≥50 4 11.43 2 4.17 1 2.78 7(5.88) 婚姻状况 4.601 0.100 未婚 18 51.43 36 75.00 27 75.00 81(68.07) 已婚 8 22.86 6 12.50 5 13.89 19(15.97) 离异或丧偶 9 25.71 6 12.50 4 11.11 19(15.97) 民族 2.077 0.038 汉族 29 82.86 44 91.67 36 100.00 109(91.60) 其他 6 17.14 4 8.33 0 0.00 10(8.40) 文化程度 0.431 0.806 初中及以下 14 31.11 18 40.00 13 28.89 45(37.82) 高中或中专 11 31.43 17 35.42 14 38.89 42(35.29) 大专以上 10 28.57 13 27.08 9 25.00 32(26.89) 户籍地 1.294 0.196 本省 7 20.00 11 22.92 12 33.33 30(25.21) 外省 28 80.00 37 77.08 24 66.67 89(74.79) 性伴数(个) 1.723 0.423 <3 25 71.43 33 68.75 22 61.11 80(67.23) 3~ < 6 7 20.00 12 25.00 12 33.33 31(26.05) ≥6 3 8.57 3 6.25 2 5.56 8(6.72) CD4+ T淋巴细胞数目(个/μl) 6.466 0.091 < 350 8 16.33 24 48.98 17 34.69 49(41.18) 350~ < 500 11 31.43 10 20.83 10 27.78 31(26.05) ≥500 16 45.71 13 27.08 8 22.22 37(31.09) 不详 0 0.00 1 2.08 1 2.78 2(1.68) 亚型 1.859 0.711 CRF01_AE 8 22.86 18 37.50 8 23.53 34(28.57) CRF07_BC 19 54.29 16 33.33 19 55.88 54(45.38) CRF55_01B 7 20.00 14 29.17 9 26.47 30(25.21) B 1 2.86 0 0.00 0 0.00 1(0.84) 表 2 深圳市龙岗区MSM HIV感染者耐药情况
Table 2. Drug resistance of MSM HIV infected individuals in Longgang District of Shenzhen City
药物类别 敏感 潜在耐药 耐药 序列数 率(%) 序列数 率(%) 序列数 率(%) Pls 115 96.64 3 2.52 2 1.68 NRTIs 116 96.48 0 0.00 3 2.52 NNRTIs 85 71.43 33 27.73 1 0.84 Pls+NRTIs 118 99.16 0 0.00 1 0.84 Pls/NNRTIs/NRTIs 82 68.91 34 28.57 5 4.20 表 3 深圳市龙岗区MSM HIV感染者耐药突变位点及耐药水平
Table 3. Drug resistance mutations and drug resistance level among MSM HIV infected individuals in Longgang District of Shenzhen City
编号 亚型 年龄
(岁)耐药突变位点 耐药水平 NRTIs NNRTIs PIs 潜在 低 中 高 6104 CRF55_01B 42 E138G, V179E EFV/ETR,
NVP/RPV647 CRF01_AE 44 M46L,
N88S,
G73SLPV/r ATV/r 702 CRF55_01B 35 E44ED,
K65RV179E I50V,K20T,
V32L, I47K,
G73R, I84IL,
N88DEFV/ETR,
NVP/RPVATV/r, DRV/r LPV/r,ABC/
FTC/3TCTDF 7143 CRF07_BC 21 E44ED, K65R,
V75IFTC/3TC ABC/TDF 556 CRF55_01B 21 M184I V179E EFV/ETR,
NVP/RPVABC FTC/3TC 注:NRTIs:核苷类反转录酶抑制剂;NNRTIs:非核苷酸类反转录酶抑制剂;PIs:蛋白酶抑制剂;EFV:依非韦仑;ETR:依曲韦林;NVP:奈韦拉平;RPV:利匹韦林;LPV/r:洛匹那韦;ATV/r:阿扎那韦;DRV/r:达芦那韦;ABC:阿巴卡韦;FTC:恩曲他滨;3TC:拉米夫定;TDF:替诺福韦。 -
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