一大型HIV-1分子簇在某低流行县传播特征分析

曾亚莉; 米家君; 吕丹; 卓玛拉措; 严图; 李菊梅; 朱俊; 康发扬; 赖文红; 侯雪芹; 梁姝; 苏玲

doi:10.16462/j.cnki.zhjbkz.2020.09.021

一大型HIV-1分子簇在某低流行县传播特征分析

doi: 10.16462/j.cnki.zhjbkz.2020.09.021

1.
610041 成都, 四川省疾病预防控制中心
2.
628200 旺苍, 旺苍县疾病预防控制中心
3.
628000 广元, 广元市疾病预防控制中心

基金项目:

四川省科技计划项目 2017JY0302

详细信息

通讯作者:
苏玲，E-mail：sl7512@163.com

中图分类号: R512.91
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- 被引次数: 0
出版历程
- 收稿日期: 2019-11-18
- 修回日期: 2020-03-03
- 刊出日期: 2020-09-10

Study on the epidemiological characteristics of a large HIV-1 molecular cluster in a low epidemic county

1.
Center for Disease Control and Prevention in Sichuan, Chengdu 610041, China
2.
Center for Disease Control and Prevention in Wangcang, Wangcang 628200, China
3.
Center for Disease Control and Prevention in Guangyuan, Guangyuan 628000, China

Funds:

Sichuan Science and Technology Program 2017JY0302

More Information

Corresponding author: SU Ling, E-mail: sl7512@163.com

摘要

摘要: 目的研究四川省某获得性免疫缺陷综合征（acquired immune deficiency syndrome，AIDS，也称艾滋病）低流行县HIV-1分子簇的特征，为开展精准干预提供依据。方法对四川省某AIDS低流行县2011年1月-2019年3月新诊断的人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染者/AIDS病人（HIV/AIDS）测定其感染HIV-1 pol基因区序列，进行分子簇分析，并对存活病例进行流行病学问卷调查。结果新诊断的113个HIV/AIDS中，有49.6%（56/113）属于同一分子簇（CRF01_AE4），该簇平均基因遗传距离为0.006 1，2011年发现首例，并呈持续快速增长的趋势（χ²_趋势=11.626，P=0.001）。簇内病例以中老年[平均年龄（50.5±13.0）岁]、文盲或小学文化（42.9%）、已婚（67.9%）、男性（76.8%）为主，感染前鲜有外出史（17.0%），45.5%经异性商业性行为感染，性交易主要发生在本地（87.5%）、低档场所（55.0%），性交易从未坚持使用安全套。75.0%经异性商业性行为感染的簇内病例为2016年及之后诊断发现；1例在得知感染后仍保持高危性行为且拒绝抗病毒治疗，在分子传播簇中与多个病例有连接关系。结论一大型传播网络在某低流行县内持续快速扩张，本地低档场所性交易是导致该网络扩张的主要原因。
- 艾滋病病毒-1 /
- 分子簇 /
- 传播特征
Abstract: Objective To study the characteristics of HIV-1 molecular clusters in a low-epidemic county in Sichuan Province, so as to provide a basis for precise intervention. Methods Research subjects included HIV/AIDS patients who were newly diagnosed from January 2011 to March 2019 in a low-epidemic county in Sichuan Province, of whom the HIV-1 pol gene was sequenced, and molecular cluster analysis was performed. Epidemiological questionnaire survey was conducted among survival cases. Results Among 113 newly diagnosed cases, 49.6% (56/113) belonged to the same molecular cluster (CRF01_AE4), and the average genetic distance of this cluster was 0.006 1. The first case was found in 2011 and there was a trend of continuous rapid growth (χ²_trend=11.626, P=0.001). The cases in the cluster were mainly seniors (average age was 50.5±13.0), low-educated (42.9%), married (67.9%), male (76.8%) and only few had a going-out history (17.0%). 45.5% were infected through heterosexual commercial sexual behaviors, and the sexual transactions mainly occurred in low-cost commercial sex venues (55.0%) in local areas (87.5%), and never consistently used condoms in the sex trade. 75.0% cases who were infected through heterosexual commercial sex were mainly diagnosed since 2016. One case, who continued having high-risk sexual behaviors after being informed and refused the anti-retroviral therapy, was found connecting with multiple cases in the molecular transmission cluster. Conclusions A large-scale transmission network had continued to expand rapidly in a HIV low-endemic county and sexual transactions in local low-cost commercial sex venues were the main reason for the network expansion.
- HIV-1 /
- Molecular cluster /
- Epidemiological characteristics

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图 1 CRF01_AE4分子传播簇示意图

Figure 1. Diagram of CRF01_AE4 cluster

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表 1 比较2011—2019年3月CRF01_AE4分子簇内病例变化

Table 1. Compare the numbers of CRF01_AE4 cases from 2011 to Mar 2019

诊断年份(年)	新诊断病例数(例)	簇内病例数(例)	簇内病例构成比(%)
2011	2	1	50.0
2012	6	0	0.0
2013	5	0	0.0
2014	16	6	37.5
2015	14	8	57.1
2016	15	7	46.7
2017	19	13	68.4
2018	28	18	64.3
2019	8	3	37.5
合计	113	56	49.6

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表 2 比较CRF01_AE4分子簇内外病例HIV感染相关特征

Table 2. Comparison of characteristics between CRF01_AE4 and non-CRF01_AE4 cases

特征	合计(N=88)^a	簇内(n=56)^a	簇外(n=32)^a	χ²值	P值
性别				1.500	0.221
男	71(80.7)	43(76.8)	28(87.5)
女	16(18.3)	13(23.2)	4(12.5)
年龄组(岁)				4.896	0.027
＜50	36(40.9)	18(32.1)	18(56.3)
≥50	52(59.1)	38(67.9)	14(43.8)
婚姻状况				2.760	0.252
未婚	8(9.1)	3(5.4)	5(15.6)
已婚	60(68.2)	39(69.6)	21(65.6)
离异、丧偶、分居	20(22.7)	14(25.0)	6(18.8)
文化程度				-2.052^b	0.040
文盲、小学	31(35.2)	24(42.9)	7(21.9)
初中	39(44.3)	23(41.1)	16(50.0)
高中及以上	18(20.5)	9(16.1)	9(28.1)
样本来源				8.239^{c, d}	0.041
医疗机构检测	63(71.6)	39(69.6)	24(75.0)
检测咨询	10(11.4)	8(14.3)	2(6.3)
阳性者配偶或性伴检测	6(6.8)	6(10.7)	0(0.0)
体检、孕检、无偿献血	9(10.3)	3(5.4)	6(18.8)
估计感染原因				12.880^d	0.005
异性商业性行为	32(36.8)	25(45.5)	7(21.9)
异性非婚非商业性行为	44(50.6)	24(43.6)	20(62.5)
配偶/固定性伴阳性	7(8.0)	6(10.9)	1(3.1)
男男性行为	4(4.6)	0(0.0)	4(12.5)
得知感染前流动				5.449	0.020
是	15(24.2)	8(17.0)	7(46.7)
否	47(75.8)	39(83.0)	8(53.3)
确诊时间				4.809	0.028
2016年之前	31(35.2)	15(26.8)	16(50.0)
2016年及之后	57(64.8)	41(73.2)	16(50.0)
首次CD4(cells/μl)				0.863	0.353
＜200	41(46.6)	24(42.9)	17(53.1)
≥200	47(53.4)	32(57.1)	15(46.9)
注：^a表示因拒答或漏答，部分变量存在缺失值；^b表示秩和检验Z值；^c表示连续性校正的χ²检验；^d表示采用Bonferroni两两比较χ²检验。

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表 3 比较CRF01_AE4分子簇内外经商业性行为感染病例HIV相关特征

Table 3. Comparison of characteristics between CRF01_AE4 and non-CRF01_AE4 cases infected through comercial sexual behavio

特征	合计(N=26)^a	簇内(n=20)^a	簇外(n=6)^a	P值^b
确诊时间				0.138
2016年之前	9(34.6)	5(25.0)	4(66.7)
2016年及之后	17(65.4)	15(75.0)	2(33.3)
首次CD4(cells/μl)				0.330
＜200	8(30.8)	5(25.0)	3(50.0)
≥200	18(69.2)	15(75.0)	3(50.0)
得知感染前外出史				0.062
有	5(19.2)	2(10.0)	3(50.0)
无	21(80.8)	18(90.0)	3(50.0)
商业性行为发生地点				0.162
本县	16(80.0)	14(87.5)	2(50.0)
县外	4(20.0)	2(12.5)	2(50.0)
首次性交易时间				1.000
2014年之前	16(61.5)	12(60.0)	4(66.7)
2014年及之后	10(38.5)	8(40.0)	2(33.3)
性交易价格(元/次)				1.000
＜50	14(53.8)	11(55.0)	3(50.0)
≥50	12(46.2)	9(45.0)	3(50.0)
性交易安全套使用				1.000
从不使用	15(57.7)	11(55.0)	4(66.7)
有时使用	11(42.3)	9(45.0)	2(33.3)
得知感染后婚外性行为				1.000
有	2(8.3)	2(10.0)	0(0.0)
无	24(91.7)	18(90.0)	6(100.0)
注：^a表示因拒答或漏答，部分变量存在缺失值；^b表示采用Fisher确切概率法。

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