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预防医学  2020, Vol. 32 Issue (10): 987-991    DOI: 10.19485/j.cnki.issn2096-5087.2020.10.004
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云南省男男性行为人群HIV/AIDS病例抗病毒治疗失败基因型耐药分析
阮尉月清1,2, 刘家法1,2, 张米2, 李健健2, 杨壁珲2, 邓雪媚2, 董兴齐1,2
1.昆明医科大学,云南 昆明 650504;
2.云南省传染病医院
Genotypic drug resistance of HIV-infected MSM who failedin antiviral therapy in Yunnan Province
RUAN Weiyueqing*, LIU Jiafa*, ZHANG Mi, LI Jianjian, YANG Bihui, DENG Xuemei, Dong Xingqi
*Kunming Medical University, Kunming, Yunnan 650504, China; Yunnan Provincial Hospital of Infectious Disease
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摘要 目的 了解云南省男男性行为人群艾滋病病毒感染者和艾滋病患者(HIV/AIDS)抗病毒治疗失败的基因型耐药情况,为提高艾滋病抗病毒治疗效果提供依据。方法 选择2014—2019年云南省确证艾滋病病毒1型阳性、经男男性行为感染且抗病毒治疗失败的HIV/AIDS病例为研究对象,采集血浆样本,采用套式反转录聚合酶链反应(RT-nPCR)扩增并测序,采用ContigExpress软件拼接测序片段,整理后序列提交至美国斯坦福大学HIV耐药数据网站比对耐药突变位点,获得序列对8种蛋白酶抑制剂(PIs)、7种核苷类反转录酶抑制剂(NRTIs)和5种非核苷类反转录酶抑制剂(NNRTIs)的耐药程度。结果 共纳入HIV/AIDS病例205例,血浆样本扩增阳性169例,耐药112例,耐药率为66.27%;不同年龄病例中,30~<50岁的耐药率较高,为76.09%;不同基因亚型中,CRF01_AE的耐药率较高,为76.34%;不同用药方案中,采用“齐多夫定+拉米夫定+奈韦拉平”的病例耐药率较高,为77.08%。NNRTIs、NRTIs和PIs耐药率分别为62.72%、49.70%和2.96%;NNRTIs中的奈韦拉平和依非韦仑耐药率较高,分别为62.72%和61.54%。与NNRTIs相关的主要突变位点为K103,37例占21.89%;与NRTIs相关的主要突变位点为M184,67例占39.64%;与PIs相关的主要突变位点为M46L/K,5例占2.96%,且导致奈非那韦高度耐药。结论 云南省男男性行为人群HIV/AIDS病例抗病毒治疗失败的耐药率相对较高,耐药的基因亚型以CRF01_AE为主,NNRTIs类药物耐药率较高,奈韦拉平和依非韦仑尤其需谨慎使用。
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阮尉月清
刘家法
张米
李健健
杨壁珲
邓雪媚
董兴齐
关键词 男男性行为者艾滋病病毒抗病毒治疗基因型耐药    
AbstractObjective To learn the genotypic drug resistance of men who have sex with men ( MSM ) with HIV who failed in antiviral therapy in Yunnan Province, in order to provide basis for improving the effect of antiviral therapy. Methods The patients who were infected with HIV-1, homosexual transmitted and failed in antiviral therapy in Yunnan Province from 2014 to 2019 were recruited. Their plasma samples were tested by reverse transcription nested polymerase chain reaction ( RT-nPCR ) , the fragments were spliced using ContigExpress, and the resistance to 8 protease inhibitors ( PIs ) , 7 nucleoside reverse transcriptase inhibitors ( NRTIs ) and 5 non-nucleoside reverse transcriptase inhibitors ( NNRTIs ) were obtained from the HIV drug resistance data website of Stanford University. Results A total of 205 HIV/AIDS cases were included, 169 positive plasma samples were amplified, 112 cases were drug resistant, and the rate of drug resistance was 66.27%. The patients who were aged 30-49 years ( 76.09% ) , had genotype of CRF01_AE ( 76.34% ) or treated by AZT+3TC+NVP ( 77.08% ) had higher resistance rate. The resistance rates of NNRTIs, NRTIs and PIs were 62.72%, 49.70% and 2.96%, respectively; the resistance rates of NVP and EFV in NNRTIs were 62.72% and 61.54%. The main mutation site associated with NNRTIs was K103, accounting for 21.89% ( 37 cases ) ; the main mutation site associated with NRTIs was M184, accounting for 39.64% ( 67 cases ) ; the main mutation sites associated with PIs were M46L/K, accounting for 2.96% ( 5 cases ) , resulting in high resistance to NFV. Conclusions The drug resistance rate of HIV-infected MSM with failure of antiviral therapy in Yunnan Province is relatively high, with CRF01_AE as the main gene subtype of drug resistance. The drug resistance rate of NNRTIs is relatively high, especially NVP and EFV.
Key wordsmen who have sex with men    human immunodeficiency virus    antiviral therapy    genotype    drug resistance
收稿日期: 2020-05-08      出版日期: 2020-09-30
ZTFLH:  R512.91  
基金资助:十三五国家科技重大专项(2018ZX10721102-002); 云南省教育厅科学研究基金项目(2018JS252)
通信作者: 董兴齐,E-mail:dongxq8001@126.com   
作者简介: 阮尉月清,硕士在读;共同第一作者刘家法,硕士,主管技师,主要从事艾滋病相关检测工作
引用本文:   
阮尉月清, 刘家法, 张米, 李健健, 杨壁珲, 邓雪媚, 董兴齐. 云南省男男性行为人群HIV/AIDS病例抗病毒治疗失败基因型耐药分析[J]. 预防医学, 2020, 32(10): 987-991.
RUAN Weiyueqing, LIU Jiafa, ZHANG Mi, LI Jianjian, YANG Bihui, DENG Xuemei, Dong Xingqi. Genotypic drug resistance of HIV-infected MSM who failedin antiviral therapy in Yunnan Province. Preventive Medicine, 2020, 32(10): 987-991.
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http://www.zjyfyxzz.com/CN/10.19485/j.cnki.issn2096-5087.2020.10.004      或      http://www.zjyfyxzz.com/CN/Y2020/V32/I10/987
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