中国少数民族地区 HIV 感染者的病毒学失败、遗传多样性和耐药性的流行情况及其决定因素：一项基于人群的研究。
Prevalence and determinants of virological failure, genetic diversity and drug resistance among people living with HIV in a minority area in China: a population-based study.
机构信息
Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China.
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
出版信息
BMC Infect Dis. 2020 Jun 23;20(1):443. doi: 10.1186/s12879-020-05124-1.
BACKGROUND
Liangshan Yi Autonomous Prefecture is one of the areas that most severely affected by human immunodeficiency virus (HIV) in China, and virological failure on antiretroviral therapy (ART) is serious in this area. Analyses of prevalence and determinants of ART failure, the genetic diversity and drug resistance among people living with HIV (PLWH) helps improve HIV treatment efficiency and prevent HIV transmission.
METHODS
A total of 5157 PLWH were recruited from 2016 to 2017. The venous blood samples were subjected to RT-PCR, followed by sequencing of the HIV-1 pol gene, targeting the protease and reverse transcriptase fragments. HIV-1 diversity was analyzed using the DNAStar software and drug resistance mutations were analyzed using the Stanford University HIV Drug Resistance Database.
RESULTS
A total of 2156 (41.81%) PLWH showed virological failure on ART. Males (ORm = 1.25), heterosexual behaviors and drug injection (ORm = 1.44) and mother to child transmission routes (ORm = 1.58), the clinical stage of AIDS (ORm = 1.35), having used illicit drugs and shared the needles (1-4 times: ORm = 1.34; more than 5 times: ORm = 1.52), having ever replaced ART regimen (ORm = 1.48) increased the risk of virological failure among PLWH, while higher education lever (ORm = 0.77) and ≥ 12 months on ART (12 ~ 36 months: ORm = 0.72; ≥36 months: ORm = 0.66) was associated with lower likelihood of virological failure. The data revealed that CRF07_BC (1508, 95.62%) were the most common strains, and the drug-resistant rate was 32.10% among PLWH with virological failure in this area. The high frequencies of drug resistance were found in EFV and NVP of NNRTIs, ABC, FTC and 3TC of NRTIs, and TPV/r in PIs. The most common mutations in NNRTIs, NRTIs and PIs were K103N/KN (64.69%), M184V/MV/I (36.29%) and Q58E/QE (4.93%), respectively.
CONCLUSION
We concluded that surveillance of virological failure, HIV-1 subtypes, and drug resistance to understand HIV-1 epidemiology and guide modification of ART guidelines, and target prevention and control strategies should be formatted to reduce the virological failure and drug resistance to promote viral suppression and prevent HIV-1 transmission.
背景
凉山彝族自治州是中国受人类免疫缺陷病毒（HIV）影响最严重的地区之一，该地区的抗逆转录病毒治疗（ART）失败率严重。分析 HIV 感染者（PLWH）ART 失败的流行情况和决定因素、HIV 基因多样性和耐药性，有助于提高 HIV 治疗效率，预防 HIV 传播。
方法
共招募了 2016 年至 2017 年的 5157 名 PLWH。采集静脉血样本进行 RT-PCR，然后对 HIV-1 pol 基因进行测序，针对蛋白酶和逆转录酶片段。使用 DNAStar 软件分析 HIV-1 多样性，使用斯坦福大学 HIV 耐药性数据库分析耐药突变。
结果
共有 2156 名（41.81%）PLWH 在 ART 中出现病毒学失败。男性（ORm=1.25）、异性性行为和注射吸毒（ORm=1.44）和母婴传播途径（ORm=1.58）、艾滋病临床分期（ORm=1.35）、使用过非法药物和共用针头（1-4 次：ORm=1.34；超过 5 次：ORm=1.52）、曾经更换过 ART 方案（ORm=1.48）增加了 PLWH 病毒学失败的风险，而较高的教育水平（ORm=0.77）和≥12 个月的 ART（12~36 个月：ORm=0.72；≥36 个月：ORm=0.66）与较低的病毒学失败可能性相关。数据显示，CRF07_BC（1508，95.62%）是最常见的株，该地区病毒学失败的 PLWH 耐药率为 32.10%。EFV 和 NVP 的 NNRTIs、ABC、FTC 和 3TC 的 NRTIs 以及 TPV/r 的 PIs 中发现耐药率较高。NNRTIs、NRTIs 和 PIs 中最常见的突变分别为 K103N/KN（64.69%）、M184V/MV/I（36.29%）和 Q58E/QE（4.93%）。
结论
我们得出结论，对病毒学失败、HIV-1 亚型和耐药性进行监测，以了解 HIV-1 流行病学并指导 ART 指南的修改，并制定有针对性的预防和控制策略，以减少病毒学失败和耐药性，促进病毒抑制，预防 HIV-1 传播。
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