Characteristics of HIV molecular transmission network and pre-treatment drug resistance of newly reported elderly HIV/AIDS patients in Lishui City(2020-2023)
Objective To explore the molecular transmission network and pre-treatment drug resistance characteristics of newly diagnosed HIV/AIDS patients aged ≥50 years in Lishui.Methods Blood samples from 246 newly reported,untreated HIV/AIDS patients from 2020 to 2023 were collected.Reverse transcription and nested PCR were performed to amplify and sequence the pol gene.The subtypes were analyzed by MEGA7.0 software to construct a phylogenetic tree.Cytoscape 3.9.0 software was used to generate molecular networks and to analyze the distribution in districts and counties.Stanford University Drug Resistance Database was employed to analyze drug-resistant mutations.Results A total of 237 pol gene sequences were obtained,revealing 8 subtypes,with CRF08_BC(51.48％,122/237),CRF01_AE(19.41％,46/237),and CRF07_BC(18.57％,44/237)being the most predominant.At a genetic distance threshold of 0.9％,19 molecular clusters were formed,and 144 sequences were included in the network,resulting in a inclusion rate of 60.76％(144/237).Five molecular clusters contained cases involving sex workers,with 43.43％(43/99)of patients in these clusters having a genetic distance threshold of ≤0.9％from sex workers.Six new clusters were formed by patients newly reported in 2022 and 2023.Four clusters had ≥5 nodes,accounting for 74.31％(107/144)of the total clustered patients.Among these 4 clusters,74.77％(80/107)had a history of non-marital heterosexual behavior,with cases mainly residing in counties A,B,and C,accounting for 74.77％(80/107),12.15％(13/107),and 9.35％(10/107),respectively.The largest cluster was composed of CRF08_BC and contained 79 cases,enrolling 22,25,25,and 7 cases from 2020 to 2023,respectively.This cluster included 2 sex workers,and 40.21％(31/77)of the patients had a genetic distance threshold of ≤0.9％from the sex workers.The rate of pre-treatment drug resistance was 12.24％(29/237).There were 4 drug-resistant clusters,with 2 located in County A and 2 in County C.Conclusions The sources of HIV transmission among elderly individuals in Lishui City are diverse,with sex workers playing a key role in transmission.Transmission clusters exhibit clear geographical aggregation,and the pre-treatment drug resistance rate has reached a moderate epidemic level.
HIVMolecular transmissionNetworkElderly peoplePre-treatment drug resistanceGeographical aggregation
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