经输血感染的HIV/AIDS患者HIV-1耐药基因突变研究

摘要

Objective To study the characteristic of HIV-1 gene mutation in HIV/AIDS patients infected by blood transfusion, and analyze the resistance to anti-HIV drugs. Methods Plasma samples were collected from 37 HIV/AIDS patients infected by blood transfusion for extraction of HIV-1 RNA. The gene fragments of HIV pol domain were amplified by RT-PCR and nested-PCR, and the electrophoresis positive products were sequenced. The sequencing result was landed to the website http: // HIV-1db.stanford.edu to analyze the drug resistance mutations. Results Drug resistance mutations were found in 20 patients, including 19 cases of virological or immunological failure. Mutation of gene locus V32AV of protease inhibitors (PIs) occurred in 3 patients during the treatment, but it did not cause the drug resistance of PIs. Mutation of the coding regions of reverse transcriptase was found in 23 patients, including M184V, TAMs, Q151M complexus, K103N, Y181C and so on. Of the 23 patients mentioned above, the HIV-1 gene mutation induced the resistance to reverse transcriptase inhibitors (RTIs) in 20 patients, and the mutation rate of RTIs was 54.05% (20/37). Conclusion The drug resistance rate of HIV-1 in patients infected by blood transfusion may be high for antiviral therapy, so the drug resistance of HIV-1 should be monitored and treatment plan should be adjusted timely.%目的 研究经输血感染的HIV-1遗传基因突变特征,分析其对抗HIV药物的耐药性.方法 经输血感染HIV-1的患者37例,从血浆提取HIV-1 RNA,运用RT-PCR和巢式聚合酶链反应(nested-PCR)扩增HIV-1 pol区基因片段,并对电泳阳性的目的片段进行测序,将结果提交到http://HIVdb.stanford.edu,分析HIV-1的耐药突变情况.结果 37例患者中共20例发生耐药突变,其中19例为病毒学或免疫学失败.3例患者在治疗过程中发生了蛋白酶抑制剂(PIs)位点突变,主要位点突变为V32AV,但未引发PIs耐药.有23例患者发生了反转录酶编码区基因突变,包括M184V、TAMs、Q151M复合体、K103N、Y181C等,其中20例HIV-1遗传基因的突变不同程度地导致了反转录酶抑制剂(RTIs)耐药,发生率为54.1％(20/37).结论 经血液感染HIV-1患者在参加抗病毒治疗后耐药发生率较高,应适时进行耐药监测,及时更新治疗方案.