无锡市HIV-1毒株耐药基因突变的调查研究

目的 了解无锡市人类免疫缺陷病毒Ⅰ型（human immunodeficiency virus 1，HIV-Ⅰ）/获得性免疫缺陷综合症（acquired immunodeficiency syndrome，AIDS）人群耐药基因变异的流行情况。方法 收集2012年10月~2013年6月无锡市HIV-1/AIDS人群血标本343例，提取前病毒DNA，采用巢式聚合酶链式反应（polymerase chain reaction，PCR）扩增HIV-1 pol区基因片段并测定编码蛋白酶和部分逆转录酶的基因序列，将序列提交至美国斯坦福大学HIV耐药数据库，进行耐药基因突变分析。结果 最终有279例成功扩增并获得了pol基因序列，共发现36例存在耐药基因突变，未用药人群的耐药率为1.8%（4/220），用药人群的耐药率为16.9%（10/59）。耐药突变主要包括D30N、L90M、K65R、M184I/V、K103N和Y181C等点突变所引起的不同类型抗病毒药物的高度或中度耐药，而其他耐药突变则引起低度或潜在低度耐药。结论 该地区HIV-1耐药株的传播尚处于低流行态势，耐药突变主要由已有抗病毒药物的使用所诱发，然而药物间的交叉耐药及耐药株的传播警示该地区应加强HIV-1/AIDS人群的耐药监测。

A survey on drug-resistance gene mutations in HIV-1 strains in Wuxi City

Objective To understand the prevalence of HIV-1 drug resistance (DR) mutations among HIV-1/AIDS patients in Wuxi City. Methods 343 blood samples of human immunodeficiency virus 1 (HIV-1)/acquired immunodeficiency syndrome (AIDS) patients were collected from October 2012 to June 2013.DNA were extracted from provirus. After partial pol gene amplification and sequencing, all sequences were evaluated for DR mutations using the Stanford University Algorithm (http://hivdb.stanford.edu). Results Eventually, 279 sequences of HIV-1 pol region were successfully amplified and sequenced. DR-related mutations were identified in 36 of the 279 viral sequences. Among drug-naive and treated individuals, the rate of HIV-1 drug resistance was 1.8% (4/220) and 16.9% (10/59), respectively. The major DR-related mutations caused high-level resistance and/or intermediate-level resistance, including D30N, L90M, K65R, M184I/V, K103N and Y181C. The others caused potential low-level resistance and/or low-level resistance. Conclusions The current HIV-1 drug resistant strains transmission is at low prevalence level in Wuxi City. The main causation which lead to DR-relate mutations is drug-induced mutation. However, cross resistance and transmission of HIV-1 DR strains suggest that DR surveillance should be strictly performed.