目的 研究凉山州某县HIV单阳家庭阴性配偶/固定性伴阳转状况及其影响因素,为进一步有效控制艾滋病疫情的传播和蔓延提供科学依据.方法 收集该县2017年1月至2018年12月艾滋病综合防治数据信息管理系统中的相关数据,建立回顾性队列研究.根据HIV单阳家庭阴性配偶/固定性伴阳转情况计算阳转率,对相关影响因素采用Log-rank检验进行单因素分析,用Cox比例风险模型进行多因素分析.结果 研究期间总共纳入单阳家庭1 372户,累计随访时间为967.45人年,94例阴性配偶/固定性伴发生HIV抗体阳转,2017-2018年总阳转率为9.72/100人年(95％CI:8.15～11.29).相比未接受ART者,接受者HIV单阳家庭阴性配偶/固定性伴阳转的风险降低(HR=0.276,95％CI:0.169～0.451),相比先证者为男性,先证者为女性的阴性配偶/固定性伴阳转的风险升高(HR=2.810,95％CI:1.398～5.651).结论 由于本研究未对阳转入群感染途径进行进一步的调查和检测,因此不能完全确定为配偶间传播,但凉山州某县HIV单阳家庭阴性配偶/固定性伴阳转率较高,应扩大ART覆盖面,加强艾滋病知识健康教育,积极采取有效的干预措施来控制该县疫情.

目的 评价1种新研发的国产人类免疫缺陷病毒(HIV)抗体检测快速确证试剂的检测性能.方法 选取四川省疾病预防控制中心既往已使用MP公司的人类免疫缺陷病毒(HIV 1+2)型抗体检测试剂盒(参比试剂)检测的确证留样样本,使用国产人类免疫缺陷病毒(HIV)抗体检测快速确证试剂(评价试剂)再次进行检测,再将评价试剂与参比试剂检测结果进行比较.结果 不一致的样本,使用核酸检测试剂对其进行HIV RNA定量检测.结果 评价试剂敏感性为98.25％[95％CI(93.18％,99.70％)],特异性为 89.29％[95％CI(81.67％,94.10％)].阳性预测值为 90.32％[95％CI(83.36％,94.68％)],阴性预测值为98.04％[95％CI(92.41％,99.66％)].结论 该评价试剂敏感性较好,特异性相对欠佳,但该试剂具备检测方便快速,无需特殊仪器设备等优点,如经进一步优化后,可为目前的检测策略提供新的方法.

Introduction: Transmitted drug resistance (TDR) can compromise antiretroviral therapy (ART) efficacy. We aimed to understand the molecular epidemiology of TDR and its genetic transmission networks among newly diagnosed people living with HIV/AIDS (PLWH). Methods: A total of 1,318 newly diagnosed PLWH, identified in all population-based HIV screening in an HIV-affected county of a minority area of China (i.e., Butuo county), were enrolled between January 1, 2018, and November 31, 2018. HIV-1 pol gene sequences were used for phylogenetic and genotypic drug resistance analyses. The genetic transmission networks were identified. Results: The prevalence of TDR among newly diagnosed PLWH was 8.12% (107/1,318). Patients in the stage of AIDS (adjusted odds ratio, OR: 2.32) and who had a history of sharing a needle ≥5 times (adjusted OR: 3.89) were more likely to have an increased risk of TDR. The prevalence of TDR for non-nucleoside reverse transcriptase inhibitors (NNRTIs) is higher than that of other inhibitors, with a relatively high prevalence of three mutations [V179D/E/DE (4.93%), K103N/KN (3.11%), and E138A/G (1.52%)]. A total of 577 (43.78%) pol sequences were involved in the genetic transmission network, with 171 clusters ranging in size from 2 to 91 pol sequences; 37.38% (40/107) of individuals carrying TDR were involved in the network, and individuals with the same TDR-associated mutations were usually cross-linked. Conclusions: Our data suggest a relatively high level of TDR and many transmission clusters among the newly diagnosed PLWH. Targeted intervention, early identification, and monitoring of resistance are warranted to reduce the TDR and prevent HIV-1 transmission in areas with a high rate of HIV-1.

Background Liangshan Yi Autonomous Prefecture is one of the areas that most severely affected by human immunodeficiency virus (HIV) in China, and virological failure on antiretroviral therapy (ART) is serious in this area. Analyses of prevalence and determinants of ART failure, the genetic diversity and drug resistance among people living with HIV (PLWH) helps improve HIV treatment efficiency and prevent HIV transmission. Methods A total of 5157 PLWH were recruited from 2016 to 2017. The venous blood samples were subjected to RT-PCR, followed by sequencing of the HIV-1 pol gene, targeting the protease and reverse transcriptase fragments. HIV-1 diversity was analyzed using the DNAStar software and drug resistance mutations were analyzed using the Stanford University HIV Drug Resistance Database. Results A total of 2156 (41.81%) PLWH showed virological failure on ART. Males (ORm=1.25), heterosexual behaviors and drug injection (ORm=1.44) and mother to child transmission routes (ORm=1.58), the clinical stage of AIDS (ORm=1.35), having used illicit drugs and shared the needles (1-4 times: ORm=1.34; more than 5 times: ORm=1.52), having ever replaced ART regimen (ORm=1.48) increased the risk of virological failure among PLWH, while higher education lever (ORm=0.77) and ≥12 months on ART (12~36 months: ORm=0.72; ≥36 months: ORm=0.66) was associated with lower likelihood of virological failure. The data revealed that CRF07_BC (1508, 95.62%) were the most common strains, and the drug-resistant rate was 32.10% among PLWH with virological failure in this area. The high frequencies of drug resistance were found in EFV and NVP of NNRTIs, ABC, FTC and 3TC of NRTIs, and TPV/r in PIs. The most common mutations in NNRTIs, NRTIs and PIs were K103N/KN (64.69%), M184V/MV/I (36.29%) and Q58E/QE (4.93%), respectively. Conclusion We concluded that surveillance of virological failure, HIV-1 subtypes, and drug resistance to understand HIV-1 epidemiology and guide modification of ART guidelines, and target prevention and control strategies should be formatted to reduce the virological failure and drug resistance to promote viral suppression and prevent HIV-1 transmission.

目的 分析凉山州布拖县特木里镇、木尔乡和九都乡(后称“两乡一镇”)艾滋病耐药毒株传播情况,利用分子传播网络技术分析耐药毒株传播来源.方法 采集2017年布拖县两乡一镇新报告未治疗的HIV-1感染者的血浆样本,扩增HIV-1 pol基因区蛋白酶和逆转录酶1.2 kb片段,进行耐药分析,同时应用HyPhy2.2.4与Cytoscape3.6.1软件与凉山州近年接受治疗且耐药患者的序列构建分子网络,分析耐药传播情况.结果 在174份血样中获得119条(68.39％)有效分析序列,13例(10.92％)出现了耐药突变,其中CRF_ 08BC亚型毒株耐药率高于CRF_07BC亚型和C亚型毒株(X2=6.884,P=0.032),地区、年龄、职业、婚姻、文化和传播途径耐药率差异无统计学意义.在11例(84.62％) CRF_07 BC亚型毒株中,3例在分子网络中与治疗患者耐药序列成簇,2例K103N突变,1例Q58E突变,其中1例为家庭内传播,其余2例与成簇序列患者关系不详.结论 布拖县两乡一镇艾滋病耐药率较高,达到中度耐药传播水平,运用分子传播网络技术,能进一步发现新报告耐药患者毒株的传播来源.