2015年江苏省HIV耐药警戒线调查

目的:了解2015年江苏省的免疫缺陷病毒(HIV)耐药株传播水平和亚型分布?方法:采用WHO的截断序贯抽样法,在江苏省获得性免疫缺陷综合征(艾滋病)疫情主要发生地南京采集47例当年新报告25岁以下HIV感染者血样,提取病毒RNA,采用RT-PCR和巢式PCR扩增HIV-1 pol区片段,并进行传播型耐药基因型分析?结果:2015年调查对象的序列成功获得率为100%(47/47),亚型以CRF01_AE亚型为主(59.6%),其次依次为CRF07_BC(25.5%)?C亚型(6.4%例)和B亚型(2.1%),并在亚型分析中发现3例URFs?江苏省HIV耐药传播水平为低流行,47份样本中发现1份样本存在传播型耐药位点突变,为蛋白酶区耐药位点突变(M46I)?该例耐药个体感染途径为同性传播,亚型为CRF01_AE?此次抽样调查发现学生所占比例最大,为46.8%(22/47),已超过商业服务人员29.8%(14/47)的比例?传播途径除1例异性传播外,其余均为同性传播?结论:江苏省首次发现传播型耐药1例,说明耐药株已开始传播?虽仍为低流行,但应密切关注耐药株传播水平的趋势变化?学生逐渐成为25岁以下感染者的主要群体,扩大对该人群的检测咨询干预工作应成为艾滋病防控工作的重点?对男男性行为做好预防措施,是控制耐药株传播的关键?

A survey of HIV drug resistance threshold in Jiangsu Province in 2015

Objective:To survey the prevalence of drug resistant and subtypes HIV in Jiangsu province in 2015. Methods:WHO truncated sequential sampling technique was adopted by using 47 samples of newly diagnosed as HIV positive and aged <25 years in Nanjing. RNA was extracted and HIV pol region was amplified by RT-PCR and nested PCR. Pol genetic mutation associated with transmitted drug resistance(TDR)was analyzed. Results:The success rate for sequence acquisition in the survey was 100%(47/47). The main subtype was CRF01_AE(59.6%),the rest subtypes in the sequence were CRF07_BC(25.5%),C(6.4%),B(2.1%),additional with 3 URFs. The prevalence of TDR in Jiangsu was low,and only 1 surveillance drug-resistance mutation(SDRMs)in protease inhibitor(PI)(M46I)was found by analyzing the 47 sequences. The individual with drug resistant HIV stain found in this study was infected by homosexual transmission and the subtype was CRF01_AE. The point finding in this study is that the percentage of HIV students was 46.8%(22/47),exceeding the percentage of HIV business servicers of 29.8%(14/47). A total of individuals with HIV were infected by homosexual transmission,except one by heterosexual. Conclusion:TDR has arisen in Jiangsu. Though the prevalence was low,we should still pay a closed attention on the tendency of TDR change. Students under age 25 are becoming the main constitution in newly diagnose HIV infections. Scanning up on consulting,testing and behavioral intervention are beneficial to HIV prevention and control. The key point on prevalence of TDR is to take preventive measures between men who have sex with men(MSMs).