德宏傣族景颇族自治州2016年HIV/HCV合并感染者HCV分子传播簇分析

摘要

目的 了解HIV/HCV合并感染者中HCV主要亚型的流行分布特征,探讨HCV主要亚型分子传播簇及其影响因素.方法 利用全国艾滋病综合防治信息系统收集2016年新报告德宏傣族景颇族自治州(德宏州)HIV/AIDS病例共1 112例,筛选出HIV/HCV合并感染且血浆量≥200μ1的318份样本,采用巢式PCR法扩增HCV的CE1和NS5B基因片段,采用ChromasPr0 1.5和BioEdit 7.0.9.0软件进行序列比对和基因型分析,采用Mega 7.0软件建立系统进化树和分子传播网络构建.结果 HIV/HCV合并感染且满足HCV基因亚型检测要求的样本有267份.HCV基因亚型呈多样化,主要有3b、6n、6u、1a、3a和其他亚型,构成比分别为32.6％(87/267)、18.4％(49/267)、15.7％(42/267)、13.1％(35/267)、11.2％(30/267)和9.0％ (24/267).1a、3a、3b、6n和6u亚型分子传播簇的总成簇率为39.1％(95/243),1a的成簇率最高,为71.4％(25/35).多因素logistic回归分析结果显示,除傣族和景颇族外的其他民族(与汉族相比,OR=0.17,95％CI:0.04～ 0.71)、已婚有配偶(与未婚相比,OR=0.42,95％CI:0.18～ 0.94),6n与3a亚型(与3b亚型相比,OR=0.34,95％CI:0.12～0.95;OR=0.22,95％CI:0.05～ 0.93)较难形成传播簇;6u和1a亚型(与3b亚型相比,OR=3.10,95％CI:1.21～7.94;OR=4.00,95％CI:1.32～12.11)较易形成传播簇.结论 德宏州HIV/HCV合并感染者的民族、婚姻状况、HCV基因亚型是HCV分子传播簇形成的关联因素.%Objective To understand the characteristics on major strain subtypes of hepatitis C virus among HIV/HCV co-infected patients,so as to explore the molecular transmission clusters and related risk factors of HCV strains.Methods A total of 336 newly reported HIV-infected patients were diagnosed as HIV/HCV co-infection in Dehong Dai and Jingpo autonomous prefecture (Dehong)in 2016.We used Nested PCR to amplify CE 1 and NS5B genes among 318 samples with plasma levels above 200 μl,before using the combining phylogenetic tree and constructing molecular propagation network method to analyze the related data.Results A total of 267 HIV/HCV co-infection patients who had met the HCV genotyping requirements were screened the gene subtypes were diversified.Among these genotypes,proportions of 3b,6n,6u,1a,3a and other subtypes appeared as 32.6％ (87/267),18.4％ (49/267),15.7％(42/267),13.1％(35/267),11.2％(30/267) and 9.0％(24/267) respectively.Molecular transmission network of five major HCV genotypes was constructed with a clustering rate of 39.1％ (95/243).The clustering rate of subtype la was the highest,as 71.4％ (25/35).Results from the multivariate logistic regression showed that ethnic minorities other than the Yi and Jingpo (vs.the Han,OR=0.17,95％ CI:0.04-0.71),the married spouses (vs.the unmarried,OR=0.42,95％ CI:0.18-0.94),the 6n and 3a subtype (vs.the 3b subtype,OR=0.34,95％CI:0.12-0.95;OR=0.22,95％CI:0.05-0.93) were more difficult to form transmission clusters.However,the 6u and 1a subtype (vs.the 3b subtype,OR=3.10,95％CI:1.21-7.94;OR=4.00,95％CI:1.32-12.11) seemed more likely to form the transmission clusters.Conclusion Ethnicity,marital status and genetic subtypes were factors significantly associated with the formation of transmission clusters related to the major HCV gene subtypes among newly reported HIV/HCV co-infection in Dehong.