【摘要】 目的 了解上海市浦东新区2019—2021年<50岁的中青年人群中未经抗病毒治疗的新确诊感染者/患者HIV-1分子流行病学特征及耐药情况，为艾滋病防治策略提供参考依据。方法 收集2019—2021年浦东新区确诊实验室HIV-1抗体首次确诊阳性且人口学信息满足条件的347份<50岁人群血样本，采用反转录聚合酶链式反应（RT-PCR）扩增HIV-pol基因，进行治疗前耐药基因检测及HIV-1亚型检测。结果 获取302例HIV-pol区基因全序列片段，HIV-1流行簇主要有CRF07＿BC(40.40%)、CRF01＿AE(36.09%)、CRF55＿01B(8.28%)；感染途径为同性性传播（72.52%）和异性性传播（27.48%）；不同性传播途径的病毒亚型分布差异有统计学意义（P=0.003）。HIV-1耐药率为5.96%，低中高度耐药均有出现，其中NNRTIs、NRTIs、PIs分别为4.97%、0.66%、0.33%；不同亚型之间的耐药率差异有统计学意义（P=0.037）。结论 上海市浦东新区2019—2021年中青年人群新确诊HIV-1感染者，基因亚型主要以CRF07＿BC、CRF01＿AE、CRF55＿01B为主，但已出现新的重组毒株，呈现多元化发展趋势，且在多种亚型中出现不同程度的治疗前耐药。更多还原

【Abstract】 Objective To investigate the molecular epidemiological characteristics and drug resistance of HIV-1among newly diagnosed antiretroviral therapy(ART)-naive infected individuals aged < 50 years in Pudong New Area,Shanghai, 2019–2021, and to provide evidence to refine local HIV prevention and control strategies. Methods Blood samples(n=374) were collected from individuals newly diagnosed with HIV infection between 2019 and 2021. Inclusion criteria were as follows:(1) confirmed first-time HIV-positive diagnosis by Western blot and without prior ART,(2) age less than 50 years,(3) voluntary participation, and(4) current residence or employment in Pudong New Area. Exclusion criteria were:(1) unsuccessful RNA extraction or sequencing,(2) mixed bases in the HIV-pol region sequence ≥5%, and(3) sequences shorter than 1 000 base pairs. The HIV-1 pol gene was amplified by reverse transcription-polymerase chain reaction(RT-PCR) for both pretreatment drug resistance genotyping and HIV-1 subtype determination, with subsequent analysis using the Stanford University HIV Drug Resistance Database for 302 successfully sequenced samples.Demographic and epidemiologic data were collected through structured in-person interviews. Results A total of 13 HIV-1 subtypes and unique recombinant forms(URFs) were identified among the 302 sequenced samples, of which 72.52%were from homosexual and 27.48% from heterosexual infections. The predominant strains were CRF07＿BC(40.40%),CRF01＿AE(36.09%) and CRF55＿01B(8.28%). A significant variance in the distribution of viral subtypes was observed among individuals infected by different sexual transmission routes(χ2=22.161, P=0.003). However, the distribution of the prevalent strains CRF01＿AE, CRF07＿BC and CRF55＿01B did not differ significantly between homosexual and heterosexual transmission(χ2=4.854, P=0.088), nor among the three age groups 15–24, 25–34 and 35–49 years(χ2=1.383, P=0.847). Resistance analysis showed a resistance rate of 5.96% in this population, with resistance levels ranging from low to intermediate to high. Non-nucleoside reverse transcriptase inhibitors(NNRTIs), nucleoside reverse transcriptase inhibitors(NRTIs) and protein inhibitors(PIs) accounted for 4.97%, 0.66% and 0.33% of resistance,respectively. The difference in resistance rates between subtypes was statistically significant(χ2=10.511, P=0.037). All cases(n=25) of the recombinant subtype CRF55＿01BC had mutations at the resistance locus, resulting in an 88.00%incidence of mutations at potential resistance loci and a 12.00% incidence of resistance associated with moderate to high levels of resistance. Conclusions From 2019 to 2021, among the newly diagnosed HIV-1 infected individuals of young and middle-aged population in Pudong New Area, Shanghai, the genetic subtypes were predominantly CRF07＿BC,CRF01＿AE and CRF55＿01B. However, new recombinant strains have emerged, indicating a trend toward diversification.In addition, varying degrees of pre-treatment drug resistance were observed in several subtypes.更多还原