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[2020年至2023年安徽省新报告艾滋病病毒/艾滋病人群病毒基因亚型分析及耐药监测结果]

[Analysis of virus gene subtypes and drug resistance monitoring results of newly reported HIV/AIDS population in Anhui Province from 2020 to 2023].

作者信息

Qin Y Z, Shen Y L, Liu A W, Wu J J, Miu L F, Fang Q, Shuai C X, Jin L

机构信息

Department of AIDS Prevention and Control, Anhui Center for Disease Control and Prevention, Hefei 230601, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2024 Aug 6;58(8):1204-1212. doi: 10.3760/cma.j.cn112150-20240308-00198.

Abstract

To investigate the genetic subtypes and drug resistance monitoring of newly reported human immunodeficiency virus (HIV) infection/AIDS virus in Anhui Province from 2020 to 2023. An observational design study was used to collect blood samples from patients diagnosed with HIV/AIDS in the AIDS Prevention and Control Department of Anhui Provincial Center for Disease Control and Prevention from January 2020 to December 2023.The HIV-1 pol gene was amplified by reverse transcription-nested PCR, and the genetic subtypes were identified by phylogenetic tree analysis using MEGA 7.0 software. The mutation sites of drug resistance were analyzed by the online software tool of Stanford University's HIV Drug resistance database. The influencing factors of drug resistance before treatment were analyzed by multivariate logistic analysis. A total of 335 plasma samples were collected, and 332 HIV-1 pol gene sequences were obtained successfully. The main gene subtypes were CRF01-AE, accounting for 35.55% (118/332), followed by CRF07-BC, B and B+C types [29.22% (97/332), 11.74% (39/332), 9.93% (33/332)]. The total drug resistance rate before treatment was 30.12%(32/100), and the drug resistance rate of protease inhibitor (PIs) in HIV-1 was 6.33% (21/332). The drug resistance rate of nucleoside reverse transcriptase inhibitors (NRTI) before treatment was 6.33% (21/332). The drug resistance rate of non-nucleoside reverse transcriptase inhibitors (NNRTI) before treatment was 17.47% (58/332).The comparison of drug resistance rate of different drug types showed statistical significance (=30.435, <0.05).Among the 100 cases of drug resistance, the main mutation point of HIV-1 protease inhibitor was Q58E (21.00%), and the main mutation point of nucleoside reverse transcriptase inhibitor was M184V/I (6.00%). Non-nucleoside reverse transcriptase inhibitor resistance mutation points mainly K103N (22.00%).There were statistically significant differences in the starting time of antiviral therapy, the number of CD4T cells at baseline and the drug resistance rate of gene subtypes (the chi-square values are respectively 24.152, 32.516, 11.652, <0.05).Multivariate logistic analysis showed that the baseline CD4T cell count was <200/μl, subtype B, subtype B+C, CRF01-AE subtype, CRF55-01B subtype and 01-BC subtype was the influential factor of drug resistance before treatment (the chi-square values are respectively 4.577, 8.202, 4.416, 5.206, 7.603 and 4.804, <0.05). The newly reported HIV/AIDS population in Anhui Province from 2020 to 2023 has a variety of viral gene subtypes, and NNRTIs are the main types of drug resistance gene mutations before treatment. Attention should be paid to the number of baseline CD4T cells, the duration of antiviral treatment, and the distribution of gene subtypes to reduce the drug resistance of HIV/AIDS patients before treatment.

摘要

为调查2020年至2023年安徽省新报告的人类免疫缺陷病毒(HIV)感染/艾滋病病毒的基因亚型及耐药监测情况。采用观察性设计研究,收集2020年1月至2023年12月安徽省疾病预防控制中心艾滋病防治科诊断为HIV/AIDS患者的血样。通过逆转录巢式PCR扩增HIV-1 pol基因,使用MEGA 7.0软件通过系统发育树分析鉴定基因亚型。利用斯坦福大学HIV耐药数据库的在线软件工具分析耐药突变位点。采用多因素logistic分析治疗前耐药的影响因素。共收集335份血浆样本,成功获得332条HIV-1 pol基因序列。主要基因亚型为CRF01-AE,占35.55%(118/332),其次为CRF07-BC、B及B+C型[29.22%(97/332)、11.74%(39/332)、9.93%(33/332)]。治疗前总耐药率为30.12%(32/100),HIV-1中蛋白酶抑制剂(PIs)的耐药率为6.33%(21/332)。治疗前核苷类逆转录酶抑制剂(NRTI)的耐药率为6.33%(21/332)。治疗前非核苷类逆转录酶抑制剂(NNRTI)的耐药率为17.47%(58/332)。不同药物类型耐药率比较差异有统计学意义(=30.435,<0.05)。在100例耐药病例中,HIV-1蛋白酶抑制剂的主要突变位点为Q58E(21.00%),核苷类逆转录酶抑制剂的主要突变位点为M184V/I(6.00%)。非核苷类逆转录酶抑制剂耐药突变位点主要为K103N(22.00%)。抗病毒治疗开始时间、基线CD4T细胞数量及基因亚型耐药率差异有统计学意义(卡方值分别为24.152、32.516、11.652,<0.05)。多因素logistic分析显示,基线CD4T细胞计数<200/μl、B亚型、B+C亚型、CRF01-AE亚型、CRF55-01B亚型及01-BC亚型是治疗前耐药的影响因素(卡方值分别为4.577、8.202、4.416、5.206、7.603及4.804,<0.05)。2020年至2023年安徽省新报告的HIV/AIDS人群存在多种病毒基因亚型,治疗前耐药基因突变以NNRTIs为主。应关注基线CD4T细胞数量、抗病毒治疗疗程及基因亚型分布,以降低HIV/AIDS患者治疗前的耐药性。

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