目的 了解广州市未接受抗病毒治疗的MSM人群HIV感染者(MSM感染者)耐药株流行状况.方法 收集2008-2015年新确证HIV-1抗体阳性、现住址为广州市、传播途径为男男性行为传播、确证时未接受过抗病毒治疗的MSM感染者血清样本,提取HIV-1 RNA,采用巢式PCR法扩增HIV-1 pol区全部蛋白酶(PR)和部分反转录酶(RT)基因片段,测序后提交到美国斯坦福大学HIV耐药数据库进行耐药分析.结果 2 283例MSM感染者中,共有1 986例血清样本成功获得pol区基因片段,年龄16～84(30.18±8.24)岁;未婚者占74.17％(1 473/1 986);汉族占90.64％(1 800/1 986);大专及以上占49.65％(986/1 986),高中及中专占27.14％(539/1 986),初中及以下占20.89％(415/1 986).HIV-1亚型以CRF07_BC和CRF01 AE为主,分别为38.22％(759/1 986)和34.49％(685/1 986).总耐药率为3.32％(66/1 986),对蛋白酶抑制剂(PIs)耐药率为1.36％(27/1 986)),对核苷类反转录酶抑制剂(NRTIs)耐药率为0.65％(13/1 986),对非核苷类反转录酶抑制剂(NNRTIs)耐药率为1.61％(32/1 986).B亚型对3类药物的耐药率均较高,CRF55_ 01B对NNRTIs耐药率高于其他亚型.B亚型对司他夫定(D4T)、依非韦仑(EFV)、奈韦拉平(NVP)的耐药率最高,均为4.17％(5/120);其次是那非那韦(NFV)、齐多夫定(AZT)、利匹韦林(RPV),均为3.33％(4/120).CRF55_01B对EFV、NVP的耐药率最高,均为5.50％(16/291);其次是依曲韦林(ETR)、RPV,均为5.15％(15/291).结论 广州市未接受抗病毒治疗的MSM感染者耐药率处于低水平,现有抗病毒药物在总体上仍是有效的.但B亚型和CRF55_01B亚型耐药率相对较高,值得关注.%Objective To understand the prevalence of drug resistance in treatment-naive HIV infected men who have sex with (MSM) in Guangzhou.Methods HIV-1 RNA were extracted from the serum specimens of the MSM newly confirmed to be HIV-1 positive,living in Guangzhou and receiving no anti-viral therapy from 2008 to 2015.HIV-1 pol gene segments,including full protease and part reverse transcriptase,were amplified by nested reverse transcription polymerase chain reaction (nested-PCR) and sequenced by Sanger.Subsequently,the sequence data were submitted to Stanford University HIV Drug Resistance Database for drug resistance analysis.Results Among 2 283 HIV infected MSM,HIV-1 pol gene segments were obtained from the serum samples of 1 986 HIV infected MSM aged 16-84 (30.18 ± 8.24) years.Among them,the unmarried accounted for 74.17％ (1 473/1 986),those of Han ethnic group accounted for 90.64％ (1 800/1 986),those with education level of college or above accounted for 49.65％ (986/1 986),those with education level of senior high school or secondary school accounted for 27.14％ (539/1 986),those with education level of junior high school or below accounted for 20.89％ (415/1 986).The distribution of subtypes was predominated by CRF07_BC (38.22％,759/1 986) and CRF01_AE (34.49％,685/1 986).The overall prevalence of drug resistance was 3.32％ (66/1 986).The prevalence of resistance to protease inhibitors (PIs),nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) were 1.36％(27/1 986),0.65％ (13/1 986) and 1.61％ (32/1 986),respectively.Subtype B had higher resistance to PIs,NRTIs and NNRTIs and subtype CRF55_01B had highest resistance to NNRTIs compared with other subtypes.In subtype B,the resistant rates to D4T,EFV and NVP were highest (all 4.17％,5/120),followed by those to NFV,AZT and RPV (all 3.33％,4/120).In subtype CRF55_01B,the resistant rates to EFV and NVP were highest (all 5.50％,16/291),followed by those to ETR and RPV (all 5.15％,15/291).Conclusions The prevalence of drug resistance in treatment-naive HIV infected MSM in Guangzhou remained at low level and current antiretroviral drugs are generally effective.However,subtype B and CRF55_01B have higher drug resistance.
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