【摘要】 目的:采用分层整群随机抽样原则,对本市95例已确诊的人类免疫缺陷病毒-1(HIV-1)感染者进行基因亚型和耐药性突变研究,以了解上海市HIV-1基因亚型及耐药性HIV-1的流行情况。方法:应用巢式RT-PCR扩增HIV-1聚合酶基因,经DNA测序后进行进化系统树分析和重组分析,以确定HIV-1基因亚型和重组体,并与国际耐药数据库比对,辨别耐药性突变位点,结合流行病学资料进行分析。结果:①在95例本市HIV感染者中经RT-PCR扩增并获得基因亚型序列70例,基因分型以CRF01_AE重组体30例(42.9%)为主,其余分别为B亚型6例(8.6%)、B’亚型10(4.3%)、G亚型2例(2.9%)、K亚型1例(1.4%)、CRF02_AG3例(4.3%)、CRF07_BC8例(11.4%)和CRF08_BC7例(10.0%),亚型间或重组体间二重重组体(CRF02_AG/CRF01_AE、B/CRF01_AE、K/G)3例(4.3%);②耐药分析结果表明,本组人群的蛋白酶抑制剂(PIs)原发耐药突变率为4.3%。在抗病毒治疗的HIV感染者15例中,11例(73.3%)发生反转录酶抑制剂(RTIs)耐药基因突变,其中核苷和非核苷类反转录酶抑制剂的耐药突变率分别为10例和11例(66.7%和73.3%),远高于未治疗者。结论:本研究分析了上海市HIV-1基因亚型和耐药突变的流行与变迁情况,对HIV-1遗传变异多样性和耐药监测体系的建立及上海市的艾滋病预防和控制工作有重要指导意义。更多还原

【Abstract】 Objective To better understand the genetic diversity and drug resistance associated mutations of HIV-1 strains currently circulating in Shanghai inhabitants. Methods Ninety-five HIV-1-infected individuals living in Shanghai were randomly sampled and their plasma was collected. HIV-1 pol gene were amplified by nest RT-PCR,sequenced and phylogenetically analyzed. Drug -resistance associated mutations in protease and reverse transcriptase regions were analyzed with Stanford University HIV/AIDS Drug Resistance Database. Results CRF01_AE predominated in Shanghai with 42.9%,followed by subtype B (8.6%),B’ (14.3%),CRF07_BC (11.4%),CRF08_BC (10%),CRF02_AG (4.3%),G (2.9%) and K (1.4%). Besides,three new inter-subtype and/or inter-CRF recombinants including B’/CRF01_AE (1.4%),U/G (1.4%),and U/CRF01_AE-like (1.4%). were detected The mutations conferring primary and secondary resistance to protease inhibitors (PIs) were detected in 3 (4.3%) of 70 patients,whereas the mutations conferring resistance to reverse transcriptase inhibitors (RTIs) were identified in 12 (17.2%) of 70 patients,among whom 11 (73.3%) of 15 and 1 (1.8%) of 55 were anti-retrovirus (ARV) treated and treatment-nave individuals,respectively (P<0.01). Conclusions This study reveals the emergence of more genetic diversity of HIV-1 currently circulating in Shanghai. HIV-1 infection by heterosexual contact is still a major route for introduction of HIV-1 variants into this city in recent years. It is believed that this information may help to guide recommendations for diagnostic assays,vaccine design and antiretroviral regimens strategies in China.更多还原