2012-2020 年保加利亚发生的传播性 HIV 耐药性存在于不同传播组和不同亚型的个体集群中。
Transmitted HIV Drug Resistance in Bulgaria Occurs in Clusters of Individuals from Different Transmission Groups and Various Subtypes (2012-2020).
机构信息
National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases (NCIPD), 1504 Sofia, Bulgaria.
Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
出版信息
Viruses. 2023 Apr 10;15(4):941. doi: 10.3390/v15040941.
Transmitted HIV drug resistance in Bulgaria was first reported in 2015 using data from 1988-2011. We determined the prevalence of surveillance drug resistance mutations (SDRMs) and HIV-1 genetic diversity in Bulgaria during 2012-2020 using polymerase sequences from 1053 of 2010 (52.4%) antiretroviral therapy (ART)-naive individuals. Sequences were analyzed for DRM using the WHO HIV SDRM list implemented in the calculated population resistance tool at Stanford University. Genetic diversity was inferred using automated subtyping tools and phylogenetics. Cluster detection and characterization was performed using MicrobeTrace. The overall rate of SDRMs was 5.7% (60/1053), with 2.2% having resistance to nucleoside reverse transcriptase inhibitors (NRTIs), 1.8% to non-nucleoside reverse transcriptase inhibitors (NNRTIs), 2.1% to protease inhibitors (PIs), and 0.4% with dual-class SDRMs. We found high HIV-1 diversity, with the majority being subtype B (60.4%), followed by F1 (6.9%), CRF02_AG (5.2%), A1 (3.7%), CRF12_BF (0.8%), and other subtypes and recombinant forms (23%). Most (34/60, 56.7%) of the SDRMs were present in transmission clusters of different subtypes composed mostly of male-to-male sexual contact (MMSC), including a 14-member cluster of subtype B sequences from 12 MMSC and two males reporting heterosexual contact; 13 had the L90M PI mutation and one had the T215S NRTI SDRM. We found a low SDRM prevalence amid high HIV-1 diversity among ART-naive patients in Bulgaria during 2012-2020. The majority of SDRMs were found in transmission clusters containing MMSC, indicative of onward spread of SDRM in drug-naive individuals. Our study provides valuable information on the transmission dynamics of HIV drug resistance in the context of high genetic diversity in Bulgaria, for the development of enhanced prevention strategies to end the epidemic.
保加利亚于 2015 年首次报告了经性传播的 HIV 耐药性,所使用的数据来自 1988 年至 2011 年。我们使用来自 2010 年(52.4%)1053 名未接受抗逆转录病毒治疗(ART)的个体的聚合酶序列,确定了 2012 年至 2020 年期间保加利亚的监测耐药突变(SDRMs)和 HIV-1 遗传多样性。使用世卫组织 HIV SDRM 清单在斯坦福大学计算人群耐药性工具中分析了 DRM。使用自动亚型工具和系统发生学推断遗传多样性。使用 MicrobeTrace 进行聚类检测和特征描述。总体 SDRM 率为 5.7%(60/1053),其中 2.2%对核苷逆转录酶抑制剂(NRTIs)耐药,1.8%对非核苷逆转录酶抑制剂(NNRTIs)耐药,2.1%对蛋白酶抑制剂(PIs)耐药,0.4%对双药 SDRM 耐药。我们发现 HIV-1 多样性很高,主要是 B 亚型(60.4%),其次是 F1(6.9%)、CRF02_AG(5.2%)、A1(3.7%)、CRF12_BF(0.8%)和其他亚型和重组形式(23%)。大多数(34/60,56.7%)SDRM 存在于不同亚型的传播簇中,这些亚型主要由男男性接触(MMSC)构成,包括一个由 12 名 MMSC 和两名报告异性接触的男性组成的 14 名成员的 B 亚型序列簇;有 13 个有 PI 突变 L90M,1 个有 NRTI SDRM T215S。我们发现,在 2012 年至 2020 年期间,未接受 ART 的患者中 HIV-1 多样性很高,但 SDRM 患病率较低。大多数 SDRM 存在于包含 MMSC 的传播簇中,表明 SDRM 在未经药物治疗的个体中继续传播。我们的研究为保加利亚高遗传多样性背景下 HIV 耐药性传播动力学提供了有价值的信息,为制定强化预防策略以终结艾滋病流行提供了依据。