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2015－2023年江苏省南京市鼓楼区新报告HIV-1感染者耐药及分子传播网络特征分析

Characteristics of drug resistance and molecular transmission network in newly reported HIV-1 infection cases in Gulou district, Nanjing, Jiangsu, 2015−2023

    摘要
  • 摘要:
    目的 通过分析2015－2023年江苏省南京市鼓楼区新报告HIV-1感染者耐药传播情况和分子网络特征，为鼓楼区艾滋病精准干预提供数据支撑。
    方法 收集2015－2023年鼓楼区新报告且未治疗感染者血浆样本，使用反转录–巢式PCR扩增HIV-1 pol区基因，构建系统进化树分析HIV-1亚型，在1.45%基因阈值下构建分子传播网络，并采用美国斯坦福大学HIV耐药数据库进行耐药分析。
    结果 共获得409例感染者基因序列，发现10种基因亚型，其中以CRF01_AE亚型（164/409，40.10%）和CRF07_BC亚型（131/409，32.03%）为主，其次为CRF119_0107亚型（36/409，8.80%）和CRF67_01B亚型（23/409，5.62%）。 治疗前耐药率为6.11%（25/409），非核苷类反转录酶抑制剂（NNRTIs）、核苷类反转录酶抑制剂、蛋白酶抑制剂耐药率分别为4.16%（17/409）、0.49%（2/409）和1.47%（6/409）。 同时，监测到传播耐药率为3.42%（14/409），耐药突变为K103N、Y181C、P225H、T215S、L90M、M46I、M46L、N83D、N88D。 共140例入网，入网率34.23%。 7例耐药病例（28.00%，7/25）被纳入4个传播簇，形成2个耐药传播簇，以NNRTIs耐药为主（71.43%，5/7），传播耐药突变主要为K103N（57.14%，4/7），集中出现在CRF07_BC耐药传播簇和CRF01_AE耐药传播簇。
    结论 鼓楼区HIV-1亚型分布多样化，治疗前耐药率已超过5%，出现了耐药毒株聚集的传播簇，应继续加强辖区内耐药毒株和耐药传播簇的动态监测，以采取针对性的措施预防和阻断鼓楼区耐药毒株流行和传播。

     

    Abstract:
    Objective To analyze the transmission of drug resistance and molecular network characteristics of newly reported HIV-1 infection cases in Gulou district of Nanjing, Jiangsu province, from 2015 to 2023, and provide data support for the targeted intervention against HIV infection.
    Methods Plasma samples were collected from the newly reported and untreated HIV-1 infection cases in Gulou from 2015 and 2023, and the HIV-1 pol region was amplified by reverse transcription-nested PCR. Phylogenetic trees were constructed to identify HIV-1 subtypes, and molecular transmission networks were established at a genetic distance threshold of 1.45%. Drug resistance profiles were analyzed by using the HIV Drug Resistance Database of Stanford University.
    Results A total of 409 HIV-1 gene sequences and 10 genotypes were obtained. The predominant subtypes were CRF01_AE (164/409, 40.10%) and CRF07_BC (131/409, 32.03%), followed by CRF119_0107 (36/409, 8.80%) and CRF67_01B (23/409, 5.62%). The rate of pretreatment drug resistance (PDR) was 6.11% (25/409), and the resistance rates to non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors, and protease inhibitors were 4.16% (17/409), 0.49% (2/409), and 1.47% (6/409), respectively. Meanwhile, the rate of transmitted drug resistance (TDR) was 3.42% (14/409) in surveillance, with drug resistance mutations being K103N, Y181C, P225H, T215S, L90M, M46I, M46L, N83D, and N88D. A total of 140 cases were connected to the network with an access rate of 34.23%. Seven drug-resistant cases were identified within 4 transmission clusters (28.00%, 7/25), with NNRTI resistance accounting for the highest proportion (71.43%, 5/7). The predominant TDR mutation was K103N (57.14%, 4/7), which was mainly found in CRF07_BC and CRF01_AE transmission clusters.
    Conclusion The subtypes of HIV-1 detected in Gulou were complex, the PDR rate exceeded 5%, and the transmission clusters harboring drug-resistant strains emerged. Therefore, it is necessary to strengthen the dynamic surveillance for drug-resistant strains and drug-resistant transmission clusters and take targeted measures for the prevention and control of the spread of drug-resistant strains.

     

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