凉山彝族自治州HIV/AIDS抗病毒治疗前HIV-1耐药情况及其影响因素分析

摘要

目的 了解凉山彝族自治州(凉山州)HIV/AIDS抗病毒治疗前HIV-1耐药情况及其影响因素,为预防HIV-1耐药毒株的传播提供参考依据.方法 分别于2017年1月1日至6月30日、2018年1月1日至6月30日在凉山州开展HIV/AIDS抗病毒治疗前HIV-1耐药的横断面调查.提取获得HIV-1 pol基因区序列,根据2014年WHO耐药监测指南的推荐标准,应用HyPhy2.2.4和Cytoscape 3.6.1软件进行HIV-1耐药毒株传播网络分析.结果 研究对象464例HIV/AIDS,HIV-1毒株为CRF07_BC亚型的占88.6％(411/464),总的HIV-1耐药率为9.9％(46/464),非核苷类反转录酶抑制剂(NNRTI)、核苷类反转录酶抑制剂(NRTI)和蛋白酶抑制剂(PI)耐药率分别为6.7％(31/464)、1.9％(9/464)和0.4％(2/464);有1组HIV-1新型重组毒株URF 01BC亚型独立成簇并携带相关耐药突变位点;多因素logistic回归分析结果显示,与异性性传播人群相比,注射吸毒人群的HIV-1耐药风险较高(aOR=3.03,95％CI:1.40～ 6.54).结论 凉山州HIV/AIDS抗病毒治疗前的HIV-1耐药率较高,且有新型重组毒株URF 01BC亚型携带相关耐药突变位点的成簇传播,建议加强HIV-1耐药毒株传播的预防工作.%Objective To explore HIV-1 drug resistance and influencing factors among people living with HIV/AIDS before antiretroviral therapy in Liangshan Yi Autonomous Prefecture (Liangshan).Methods Between January 1 and June 30,in both 2017 and 2018,a cross-sectional survey was conducted in Liangshan HIV-1 pol sequences were gathered and analyzed according to WHO Guidelines on HIV drug resistance surveillance of 2014.Both HyPhy 2.2.4 and Cytoscape 3.6.1 software were used to analyze the drug resistant strains of HIV-1 transmission network.Results A total of 464 people living with HIV/AIDS was recruited.The proportion of HIV-1 CRF07_BC subtype was 88.6％ (411/464),with HIV-1 drug resistance rate was 9.9％ (46/464).The HIV-1 drug resistance rates of non-nucleoside reverse transcriptase inhibitors (NNRTI),nucleoside reverse transcriptase inhibitors (NRTI) and protease inhibitors (PI) were 6.7％ (31/464),1.9％ (9/464) and 0.4％ (2/464) respectively.New recombinant strains of HIV-1 URF_01BC subtype was independently clustered according to the drug resistant mutation sites.Results from the multivariate logistic analysis showed that injected drug users group had higher risk on HIV-1 drug resistance (aOR=3.03,95％ CI:1.40-6.54) than heterosexual group among people living with HIV/AIDS.Conclusions HIV-1 drug resistance rate had already been in a high level before antiretroviral therapy was in place.The newly identified recombinant strains of HIV-1 URF_01BC subtype were independently clustered according to the drug resistant mutation sites.It was necessary to strengthen the prevention of the HIV-1 drug resistant strains transmission.