深圳市龙岗区男男性接触者HIV感染者流行病学特征及原发性耐药分析

王小丽; 周健明; 金玉娟; 龙清平; 李静媚

doi:10.16462/j.cnki.zhjbkz.2021.12.015

深圳市龙岗区男男性接触者HIV感染者流行病学特征及原发性耐药分析

doi: 10.16462/j.cnki.zhjbkz.2021.12.015

518172 深圳，深圳市龙岗区疾病预防控制中心应急办

基金项目:

深圳市龙岗区科技创新专项资金 LGKCYLWS2020122

详细信息

通讯作者:
李静媚，E-mail: lijingmei10@126.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: 2021-04-06
- 修回日期: 2021-07-07
- 网络出版日期: 2021-12-27
- 刊出日期: 2021-12-10

Analysis on the epidemiological characteristics and transmitted drug resistance of MSM HIV infected individuals in Longgang District, Shenzhen City

Department of Emergency, Longgang Center for Disease Control and Prevention of Shenzhen, Shenzhen 518172, China

Funds:

Shenzhen Longgang District Science and Innovation Special Fund Project LGKCYLWS2020122

More Information

Corresponding author: LI Jing-mei, E-mail: lijingmei10@126.com

摘要

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。
- 流行病学特征 /
- MSM /
- 耐药分析
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.
- Epidemiological characteristics /
- MSM /
- Resistance analysis

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图 1 深圳市龙岗区MSM HIV感染者的pol区进化树分析

注：◆表示HIV标准参考株。

Figure 1. Phylogenetic tree analysis of pol gene of MSM HIV infected individuals in Longgang District of Shenzhen City

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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
人群特征	例数	构成比(%)	例数	构成比(%)	例数	构成比(%)	合计[n(%)]	H/Z值	P值
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)

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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
药物类别	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

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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
编号	亚型	年龄 (岁)	NRTIs	NNRTIs	PIs	潜在	低	中	高
6104	CRF55_01B	42		E138G, V179E			EFV/ETR, NVP/RPV
647	CRF01_AE	44			M46L, N88S, G73S		LPV/r		ATV/r
702	CRF55_01B	35	E44ED, K65R	V179E	I50V，K20T, V32L, I47K, G73R, I84IL, N88D	EFV/ETR, NVP/RPV	ATV/r, DRV/r	LPV/r，ABC/ FTC/3TC	TDF
7143	CRF07_BC	21	E44ED, K65R, V75I				FTC/3TC	ABC/TDF
556	CRF55_01B	21	M184I	V179E		EFV/ETR, NVP/RPV	ABC		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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