在中国特大城市实施“治疗即预防”后，HIV-1 传播耐药株的流行率增加且稳定聚集率不变。

Increased prevalence and stable clustering rate of HIV-1 transmitted drug resistance strains after 'treat-all' in a megacity of China.

机构信息

Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China.

Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong 518055, China.

出版信息

J Antimicrob Chemother. 2023 Jul 5;78(7):1795-1799. doi: 10.1093/jac/dkad175.

DOI:10.1093/jac/dkad175

PMID:37279764

Abstract

OBJECTIVES

The 'treat-all' strategy was implemented in Shenzhen, China in 2016. The effect of this extensive treatment on transmitted drug resistance (TDR) of HIV is unclear.

METHODS

TDR analysis was performed, based on the partial HIV-1 pol gene obtained from the newly reported HIV-1 positive cases from 2011 to 2019 in Shenzhen, China. The HIV-1 molecular transmission networks were inferred to analyse the spread of TDR. Logistic regression was used to identify the potential risk factors with TDR mutations (TDRMs) to cluster.

RESULTS

A total of 12 320 partial pol sequences were included in this study. The prevalence of TDR was 2.95% (363/12 320), which increased from 2.57% to 3.52% after 'treat-all'. The TDR prevalence was increased in populations with the characteristics of CRF07_BC, being single, educated to junior college level and above, MSM and male. The sensitivities of viruses to six antiretroviral drugs were decreased. The clustering rate of TDRMs remained stable, and the sequences in the three drug resistance transmission clusters (DRTCs) were mainly found during 2011-16. CRF07_BC and CRF55_01B were the factors associated with TDRMs clustering in the networks.

CONCLUSIONS

The 'treat-all' strategy might have contributed to a small increase in TDR, while most of the TDRMs were distributed sporadically, which implies that the 'treat-all' strategy is helpful for the control of TDR in high-risk populations.

摘要

目的

2016 年中国深圳实施了“治疗所有”策略。这种广泛治疗对艾滋病毒传播耐药性（TDR）的影响尚不清楚。

方法

根据 2011 年至 2019 年期间在中国深圳新报告的艾滋病毒 1 型阳性病例获得的部分 HIV-1 pol 基因，进行 TDR 分析。推断 HIV-1 分子传播网络以分析 TDR 的传播。使用逻辑回归识别具有 TDR 突变（TDRMs）的潜在危险因素进行聚类。

结果

本研究共纳入 12320 个部分 pol 序列。TDR 的流行率为 2.95%（363/12320），“治疗所有”后从 2.57%增加到 3.52%。在具有 CRF07_BC、单身、受过大专及以上教育、男同性恋和男性特征的人群中，TDR 的流行率增加。六种抗逆转录病毒药物对病毒的敏感性降低。TDRMs 的聚类率保持稳定，三个耐药性传播簇（DRTCs）中的序列主要发现于 2011-16 年期间。CRF07_BC 和 CRF55_01B 是网络中与 TDRMs 聚类相关的因素。