桂林市2019—2023年HIV/AIDS患者抗病毒治疗失败后耐药情况分析
Characteristics of drug resistance in HIV/AIDS patients with antiretroviral treatment failure in Guilin city, 2019-2023
目的:探究桂林市HIV/AIDS患者在抗病毒治疗(antiretroviral treatment,ART)失败后HIV-1耐药情况。方法:采集桂林市2019年1月至2023年12月接受ART时间≥1年且HIV病毒载量≥1 000拷贝/ml的患者血浆样本,同时收集其人口学信息,进行HIV-1基因型亚型分析和耐药检测,以确定耐药突变位点及毒株对药物的敏感性。结果:共收集ART失败并成功扩增的患者样本766例,其中男性536例(69.97%,536/766),平均年龄为54岁;共检出8种HIV-1亚型,其中以CRF01_AE(80.55%,617/766)、CRF07_BC(11.10%,85/766)和CRF08_BC(6.92%,53/766)为主。耐药分析结果显示,HIV-1耐药率为34.86%(267/766),对核苷类反转录酶抑制剂(nucleoside reverse transcriptase inhibitors,NRTIs)、非核苷类反转录酶抑制剂(non-nucleoside reverse transcriptase inhibitors,NNRTIs)和蛋白酶抑制剂(protease inhibitors,PIs)的耐药均有发生,其中以NRTIs/NNRTIs双重耐药(48.31%,129/267)和NNRTIs耐药(43.07%,115/267)为主。共检测到37个耐药突变位点,14个NRTIs相关的突变位点主要包括M184V/I(47.57%,127/267)、K65R(18.73%,50/267)、K70E/N/T/G/R(13.11%,35/267)等;18个NNRTIs相关的突变位点主要包括K103N/R(56.93%,152/267)、V179D/E/T(21.72%,58/267)、G190C/S/Q(17.23%,46/267)和V106I/M(16.85%,45/267)等;5个PIs相关的突变位点以L10V/I突变率最高(3.00%,8/267)。4种NRTIs相关、3种NNRTIs相关和1种PIs相关的耐药突变位点在不同亚型的流行率存在显著差异( P<0.05)。 结论:桂林市HIV/AIDS患者抗病毒治疗效果良好,耐药发生率总体较低,但未来仍需加强监测,减少耐药株的传播。
更多Objective:To explore the HIV-1 drug resistance in patients with HIV/AIDS in Guilin city following the failure of antiretroviral treatment (ART).Methods:Plasma samples were collected from patients in Guilin who had received ART for more than 1 year and had a HIV viral load greater than or equal to 1 000 copies/ml from January 2019 to December 2023, and demographic information was also collected for HIV-1 genotype subtype analysis and drug resistance testing to determine the resistance mutation loci and the susceptibility of the strains to drugs.Results:A total of 766 patient samples with failed ART collection and successful amplification were collected, of which 536 (69.97%, 536/766) were male, with an average age of 53 years; a total of 8 HIV-1 subtypes were detected, with CRF01_AE (80.55%, 617/766), CRF07_BC (11.10%, 85/766) and CRF08_BC (6.92%, 53/766) predominated. The drug resistance analysis showed that the HIV-1 drug resistance rate was 34.86% (267/766), including nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitor (PI), with dual resistance to NRTIs/NNRTIs (48.31%, 129/267) and NNRTIs resistance (43.07%, 115/267) predominantly. A total of 37 resistance mutation sites were detected, 14 NRTIs-associated mutation sites mainly included M184V/I (47.57%, 127/267), K65R (18.73%, 50/267), K70E/N/T/G/R (13.11%, 35/267), etc., and 18 NNRTIs-associated mutation sites mainly included K103 N/R (56.93%, 152/267), V179 D/E/T (21.72%, 58/267), G190C/S/Q (17.23%, 46/267), and V106I/M (16.85%, 45/267), etc.; and 5 PIs-associated mutation sites was the highest with L10V/I mutation rate (3.00%, 8/267).Conclusions:HIV/AIDS patients in Guilin have shown favorable outcomes in antiviral therapy, with a relatively low overall incidence of drug resistance. However, it is essential to enhance surveillance to reduce the spread of drug-resistant strains in the future.
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