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目的研究经输血感染的HIV-1遗传基因突变特征,分析其对抗HIV药物的耐药性。方法经输血感染HIV-1的患者37例,从血浆提取HIV-1 RNA,运用RT-PCR和巢式聚合酶链反应(nested-PCR)扩增HIV-1 pol区基因片段,并对电泳阳性的目的片段进行测序,将结果提交到http://HIVdb.stanford.edu,分析HIV-1的耐药突变情况。结果 37例患者中共20例发生耐药突变,其中19例为病毒学或免疫学失败。3例患者在治疗过程中发生了蛋白酶抑制剂(PIs)位点突变,主要位点突变为V32AV,但未引发PIs耐药。有23例患者发生了反转录酶编码区基因突变,包括M184V、TAMs、Q151M复合体、K103N、Y181C等,其中20例HIV-1遗传基因的突变不同程度地导致了反转录酶抑制剂(RTIs)耐药,发生率为54.1%(20/37)。结论经血液感染HIV-1患者在参加抗病毒治疗后耐药发生率较高,应适时进行耐药监测,及时更新治疗方案。
Objective To investigate the characteristics of HIV-1 genetic mutations in transfusion-infected patients and to analyze their resistance to HIV drugs. Methods Totally 37 HIV-1 infected patients were transfused with HIV-1 RNA. The HIV-1 pol gene fragment was amplified by RT-PCR and nested-PCR, The fragments were sequenced and the results were submitted to http://HIVdb.stanford.edu for analysis of drug-resistant mutations in HIV-1. Results A total of 20 of 37 patients developed resistance mutations, of which 19 were virological or immunological failure. Three patients had protease inhibitor (PIs) site mutations during treatment, the main site mutation was V32AV, but did not lead to PIs resistance. There were 23 cases of reverse transcriptase coding region mutations, including M184V, TAMs, Q151M complex, K103N, Y181C, etc., of which 20 cases of HIV-1 gene mutations to varying degrees led to reverse transcriptase inhibitors (RTIs) resistance, the incidence was 54.1% (20/37). Conclusion The HIV-1 patients infected by blood have a higher incidence of drug resistance after participating in antiviral therapy. Drug resistance monitoring should be conducted in time to update the treatment plan.