Liu Huanxia, He Shenghua, Yang Tongtong, Cai Lin, Cheng Dianxia
（ 610061） Infectious Disease Department, Public Health Clinical Center of Chengdu, Chengdu 610061, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2024 Sep 20;55(5):1295-1300. doi: 10.12182/20240960209.
To investigate the distribution characteristics of HIV-1 subtypes, the status of transmitted drug resistance (TDR), and the influencing factors of TDR in treatment-naive patients with AIDS who are hospitalized.
Treatment-naive patients with AIDS who were admitted to the Infectious Disease Department, Public Health Clinical Center of Chengdu between January 2020 and December 2022 were enrolled in the study. The diagnosis and confirmation diagnosis of all the subjects were made at the same hospital. Blood samples were collected from the subjects before antiretroviral therapy (ART). The in-house method was used for HIV gene amplification and sequencing. A phylogenetic tree was constructed to analyze the HIV-1 subtypes. The Stanford HIV Drug Resistance Database was used to conduct an online comparative analysis of the drug resistance mutation sites and to determine the types and levels of drug resistance. The distribution characteristics of HIV-1 subtypes, the occurrence of TDR, and the influencing factors of TDR were analyzed.
A total of 213 patients were included in the study and their blood samples were collected. HIV-1 subtypes were successfully amplified in 83.10% (177/213) of the subjects. Ten HIV subtypes were identified, with CRF07_BC being the most common subtypes, accounting for 43.50% (77/177), which was followed by CRF01_AE at 37.85%. Unique recombinant forms (URFs) were relatively uncommon, accounting for 8.47%. The other subtypes accounted for 10.17%. These 4 categories of HIV-1 subtypes were distributed with statistically significant differences in different age groups (=0.024). Further analysis revealed significant differences in the distribution of the HIV-1 subtypes of CRF01_AE and URFs between the groups of patients aged 30-50 years and those over 50. In addition, URFs accounted for a higher proportion in patients aged 30 to 50 years (=0.008). The incidences of TDR were 6.49%, 8.96%, 13.33%, and 5.56% for CRF07_BC, CRF01_AE, URFs, and other subtypes, respectively, showing no significant difference (>0.05). The overall TDR was 6.57%. The TDR for non-nucleoside reverse transcriptase inhibitors (NNRTIs) was 5.16%, and the main mutation sites were V179D/E, E138A/G, V106M/I, and Y181C. The TDR for nucleoside reverse transcriptase inhibitors (NRTIs) was 1.88%, and the main mutation site was M184V. One patient was found to be resistant to both NNRTIs and NRTIs. The highly resistant rate was 4.23%, moderate resistance was 0.47%, and low resistance was 1.88%. No significant effects of the specific years, demographic characteristics, transmission route, baseline condition, and opportunistic infections on TDR were found in this study (>0.05).
The HIV-1 subtypes are diverse and complex in treatment-naive patients with AIDS who were hospitalized. The overall prevalence of TDR is relatively high. It is necessary to strengthen HIV drug resistance testing to optimize ART treatment and reduce the risk of drug resistance transmission.
探讨住院的初治艾滋病患者中HIV-1亚型的分布特征、传播耐药（TDR）状况及TDR的影响因素。
选取2020年1月至2022年12月在成都市公共卫生临床中心感染科住院的初治艾滋病患者纳入研究。所有研究对象均在同一医院进行诊断及确诊诊断。在抗逆转录病毒治疗（ART）前采集研究对象的血样。采用自建方法进行HIV基因扩增及测序。构建系统发育树分析HIV-1亚型。利用斯坦福HIV耐药数据库对耐药突变位点进行在线比对分析，确定耐药类型及水平。分析HIV-1亚型的分布特征、TDR的发生情况及TDR的影响因素。
共纳入213例患者并采集其血样。83.10%（177/213）的研究对象成功扩增出HIV-1亚型。共鉴定出10种HIV亚型，其中CRF07_BC为最常见亚型，占43.50%（77/177），其次是CRF01_AE，占37.85%。独特重组型（URF）相对少见，占8.47%。其他亚型占10.17%。这4类HIV-1亚型在不同年龄组中的分布差异有统计学意义（P = 0.024）。进一步分析显示，30至50岁组与50岁以上组患者的CRF01_AE和URF的HIV-1亚型分布存在显著差异。此外，URF在30至50岁患者中占比更高（P = 0.008）。CRF07_BC、CRF01_AE、URF和其他亚型的TDR发生率分别为6.49%、8.96%、13.33%和5.56%，差异无统计学意义（P>0.05）。总体TDR为6.57%。非核苷类逆转录酶抑制剂（NNRTIs）的TDR为5.16%，主要突变位点为V179D/E、E138A/G、V106M/I和Y181C。核苷类逆转录酶抑制剂（NRTIs）的TDR为1.88%，主要突变位点为M184V。发现1例患者对NNRTIs和NRTIs均耐药。高耐药率为4.23%，中度耐药为0.47%，低度耐药为1.88%。本研究未发现特定年份、人口学特征、传播途径、基线状况及机会性感染对TDR有显著影响（P>0.05）。
住院的初治艾滋病患者中HIV-1亚型多样且复杂。TDR总体流行率相对较高。有必要加强HIV耐药检测，以优化ART治疗并降低耐药传播风险。
