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目的对上海市2013年新发现的男男性行为(MSM)人群未经抗病毒治疗的艾滋病病毒1型(HIV-1)感染现况进行调查,为上海市老年人群医疗保障措施及艾滋病防治对策提供参考。方法知情同意前提下,对新发现HIV感染者进行个案流行病学调查并采集血样,进行反转录-聚合酶链反应扩增、DNA测序与亚型鉴定。将52例≥50岁年龄组与591例<50岁年龄组人群做相应对比,揭示该人群人口学、行为学及基因亚型的分布特征。结果≥50岁MSM人群亚型分析结果以CRF01_AE为主,占48.1%(25/52),其次为CRF07_BC占26.9%(14/52),B亚型占11.5%(6/52),CRF08_BC占3.8%(2/52),01B亚型为9.6%(5/52)。CRF01_AE在≥50岁年龄组中的比例(48.1%)明显低于<50岁年龄组的63.8%(χ2=11.18,P<0.05),并且在病程进展及死亡等方面差异有统计学意义,提示在≥50岁年龄组可能更容易进展到艾滋病期。结论上海市≥50岁MSM人群感染者以上海本地户籍为主,虽然基因亚型也以CRF01_AE亚型为主,但基因亚型呈多样性。应重视该人群亚型的发展和演变,有针对性地加强本地户籍≥50岁男性艾滋病宣传、高危行为干预,制定科学并有针对性的艾滋病防治策略。
Objective To investigate the status of untreated HIV-1 infection in newly discovered MSM population in Shanghai in 2013, and to provide evidences for the medical security measures and AIDS prevention and control measures for the elderly population in Shanghai reference. Methods Based on informed consent, a case-by-case epidemiological survey of new HIV-infected persons was conducted and blood samples were collected for reverse transcription-polymerase chain reaction amplification, DNA sequencing and identification of subtypes. 52 cases of ≥50 years of age group and 591 cases of <50 years of age groups were compared to reveal the population demography, behavior and distribution characteristics of subtypes. Results The prevalence of subtypes of MSM ≥50 years old was mainly CRF01_AE, accounting for 48.1% (25/52), followed by 26.9% (14/52) with CRF07_BC, 11.5% (6/52) with B subtype, and CRF08_BC 3.8% (2/52), 01B subtype was 9.6% (5/52). CRF01_AE was significantly lower in patients ≥50 years (48.1%) than in 63.8% (χ2 = 11.18, P <0.05) in patients <50 years of age, with significant differences in progression and death In the age group of> 50 years, it may be easier to advance to AIDS. Conclusion In Shanghai, individuals with MSM ≥50 years old are mainly from Shanghai. Although the genotypes are mainly CRF01_AE subtypes, their genotypes are diverse. Should pay attention to the development and evolution of the subtype of the population, targeted to strengthen local residents aged 50 or older AIDS awareness, high-risk behavior intervention, the development of scientific and targeted AIDS prevention and control strategies.