浙江省台州市新报告男男性行为人群人类免疫缺陷病毒原发耐药及分子传播特征

汪剡灵; 吴烜赫; 李桂霞; 王婷婷; 王雅婷; 陈泰霖; 沈伟伟; 谢亚莉; 林海江; 何纳; 陈潇潇

doi:10.19428/j.cnki.sjpm.2025.24830

浙江省台州市新报告男男性行为人群人类免疫缺陷病毒原发耐药及分子传播特征

Characteristics of HIV primary drug resistance and molecular transmission clusters in newly reported men who had sex with men in Taizhou City， Zhejiang Province

摘要

摘要:
目的了解浙江省台州市男男性行为人群（MSM）人类免疫缺陷病毒1型（HIV⁃1）感染的分子流行特征，为艾滋病防控工作提供参考依据。
方法研究对象为2020—2023年台州市所有新报告MSM，收集其未经抗病毒治疗的血液样本，扩增HIV‑1 pol基因并测序，提交序列至斯坦福大学耐药数据库，确定耐药突变位点以及耐药性。使用MEGA 11.0软件分析核酸序列，构建系统进化树，计算基因序列遗传距离，使用Cytoscape_v3.10.1构建HIV‑1分子传播网络图，采用logistic回归分析成簇的影响因素。
结果纳入363例新报告MSM人类免疫缺陷病毒（HIV）感染者，中位年龄［M（P₂₅，P₇₅）］为34（26，47）岁，以初中及以下文化程度（55.65%）为主。发现8种亚型，以CRF07_BC和CRF01_AE亚型为主。原发性耐药率为10.47%（38/363）。最适分子网络基因距离为0.019，入网率42.70%（155/363），共形成47个分子簇。多因素logistic分析结果显示，与CRF01_AE亚型相比，CRF07_BC亚型成簇风险更高（OR=1.916，95%CI：1.191~3.109），耐药病例较未发现耐药者成簇风险更高（OR=2.011，95%CI：1.006~4.080），新近感染者较长期感染者进入最大分子簇风险低（OR=0.376，95%CI：0.137~0.928）。
结论浙江省台州市MSM新发感染活跃，原发耐药水平较高，携带耐药毒株的个体更易成簇，应加强耐药监测，防止耐药毒株在网络中进一步传播。

Abstract:
Objectives To investigate the molecular epidemiological characteristics of HIV-1 infection among men who had sex with men (MSM) in Taizhou City, Zhejiang Province, and to provide a scientific reference for acquired immune deficiency syndrome prevention and control efforts.
Methods The research subjects were all newly reported MSM population in Taizhou City from 2020 to 2023. Blood samples without antiviral therapy were collected. The HIV-1 pol gene was amplified and sequenced, and the sequences were submitted to the Stanford University drug resistance database to identify the mutation sites and drug resistance. MEGA 11.0 software was used to analyze the nucleic acid sequences, construct phylogenetic tree, and calculate genetic distance of gene sequences. The molecular transmission network diagram of HIV-1 was constructed using Cytoscape_v3.10.1, and the influencing factors of network entry were analyzed by logistic regression.
Results A total of 363 newly reported HIV-infected MSM patients were included, with a median age M (P₂₅, P₇₅) of 34 (26,47) years old. The majority had an educational level of junior high school or below (55.65%). A total of eight subtypes were found, mainly CRF07_BC and CRF01_AE. The primary drug resistance rate was 10.47% (38/363). The optimal molecular network gene distance was 0.019, with a network access rate of 42.70% (155/363), and a total of 47 molecular clusters were formed. Multivariate logistic analyses showed that compared with the CRF01_AE subtype, the clustering risk of CRF07_BC subtype was higher (OR=1.916, 95%CI: 1.191‒3.109), cases with drug resistance had a higher risk of cluster formation than those without drug resistance (OR=2.011, 95%CI: 1.006‒4.080), and recent infected patients had a lower risk of entering the largest molecular cluster than long-term infected patients (OR=0.376, 95%CI: 0.137‒0.928).
Conclusion The newly diagnosed infections among the MSM population are active in Taizhou City, Zhejiang Province, with a high level of primary drug resistance. Individuals carrying drug-resistant strains are more likely to cluster. Drug resistance monitoring should be strengthened to prevent further spread of drug-resistant strains in the network.

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