| Objectives:This study describes the prevalence of HIV/MTB and HIV/NTM,and collects important laboratory indicators such as immunology,blood routine,liver and kidney function,blood glucose,and lipids of HIV/MTB and HIV/NTM patients for comparison.The purpose of this study is to provide a basis for the clinical preliminary identification of HIV/MTB and HIV/NTM,while exploring the differences in laboratory indicators among different strains of NTM.In addition,describe MTB resistance and genotype,describe the prevalence of drug resistant tuberculosis in this region,and further explore the relationship between genotype and drug resistance.Methods:This study selected HIV/MTB and HIV/NTM patients from Yunnan Infectious Diseases Hospital from 2018 to 2022 as the research objects,and collected demographic data,laboratory indicators and NTM strains.In addition,the MTB patients from Yunnan Infectious Diseases Hospital from April to September 2021 were collected as the research objects,and the second generation sequencing technology was used to detect the resistance of MTB and the MIRU-VNTR technology was used for genotyping to further explore the relationship between genotype and drug resistance.Results:1.A total of 346 patients with HIV/MTB and HIV/NTM were included in this study,of which 74.3%were male;The age is 42(35,51)years old;The ethnic group is mainly Han,accounting for 66.5%;The main marital status was married or with spouse,accounting for 59.0%;The highest proportion of farmers is 85.8%;290patients with HIV/MTB infection accounted for 83.8%,and 56 patients with HIV/NTM accounted for 16.2%.2.In HIV/MTB patients,the average HGB level of men is higher than that of women,and the average HGB level of men and women is lower than the normal range;The level of CD4~+T cells in married or married patients was higher than that in unmarried patients(P=0.014);The level of CD8~+T cells in unmarried patients was higher than that in divorced or widowed patients(P=0.014).3.In HIV/NTM patients,the T-Bil level of Han patients was higher than that of ethnic minority patients(P=0.013);The level of UREA in married patients was higher than that in unmarried patients(P=0.033);Male CREA level was higher than female(P=0.036);The level of UA in women is lower than that in men(P=0.002);≥the TC level of patients aged 60 was higher than that of patients aged 20～39 and 40～59.A total of 56 strains were identified by NTM,of which 42 strains(75.0%)were M.avium,followed by 10.7%of M.intercelleulare,and the highest proportion of M.avium complex was 85.7%;The level of CD8~+T cell count of M.kansasii was higher than that of M.intercelleulare(P=0.022).4.There were significant differences in the distribution of CD4~+T cells,WBC,RBC,HGB and TG between HIV/MTB patients and HIV/NTM patients.CD4~+T cell count in HIV/MTB patients was higher than that in HIV/NTM patients(P<0.001);The WBC level of HIV/NTM patients was lower than that of HIV/MTB patients(P<0.001);The RBC level of HIV/MTB patients was higher than that of HIV/NTM patients(P=0.044),and the HGB level of HIV/NTM patients was lower than that of HIV/MTB patients(P=0.037).5.In this study,94 strains of MTB were sequenced.Among 94 patients with MTB,male accounted for 63.8%;The age is 52(36,61)years;The number of newly treated patients was 79.8%;The main type of specimen was sputum,accounting for 77.7%;The genotype was mainly Beijing type,accounting for 67.0%;There were 35 patients with drug resistance,the overall drug resistance rate was 37.2%,of which the MR rate was21.3%,the PDR rate was 10.6%,the MDR rate was 2.1%,and the XDR rate was 3.2%.The MR rate of newly treated patients was 18.7%,the PDR rate was 8.0%,and the MDR rate was 2.7%;The MR rate of retreated patients was 31.6%,the PDR rate was21.1%,and the XDR rate was 15.8%.There was no statistically significant difference in the distribution of drug resistance types among different genotypes,but there was a statistically significant difference in the distribution of drug resistance(P=0.002)and drug resistance types(P=0.001)between newly treated and retreated patients.6.After sequencing of 94 strains of MTB isolates,35 strains were resistant,and the top five were INH(23.4%),EMB(12.8%),FQs(10.6%),RFP(7.4%),SM(4.3%)from high to low;Comparing the drug resistance rate of the patients with initial treatment with that of the patients with retreatment,there was a statistically significant difference in the drug resistance rate between the three drugs:INH(P=0.014),RFP(P=0.041)and FQs(P<0.001),all the drug resistance rates of the patients with retreatment were higher than those of the patients with initial treatment.7.Among the 22 INH resistant strains,the main mutation was kat G S315T,accounting for 81.8%;A total of 7 strains of RFP resistance occurred in the rpo B gene,mainly L533P,accounting for 42.9%;There were 12 strains of EMB resistance,and all mutations occurred at 306 site of emb B;Among the four isolates resistant to SM,all mutations were K88R in the rps L gene;There are 10 strains resistant to FQs,all of which are gyr A genes,and the mutation rate of 94 sites is 60.0%;Only one strain was resistant to secondline injection drugs and mutated into A1401G in rrs gene.Conlusions:1.The CD4 cell levels in HIV/MTB patients and HIV/NTM patients are both below the normal range.HIV/NTM patients have lower CD4 cell counts,WBC levels,RBC levels,and HGB levels than HIV/MTB patients.HIV/NTM patients have more severe immune deficiency and are more prone to anemia than HIV/MTB patients.2.The NTM isolation rate of HIV/AIDS patients is 16.2%,with the main NTM strains being M.avium,M.intercelleulare,and M.kansasii.The highest proportion of M.avium complex is 85.7%,which is the dominant microbial community in this region.3.The overall resistance rate of MTB strains in this article is 37.2%,with MR rate of21.3%,PDR rate of 10.6%,MDR rate of 2.1%,and XDR rate of 3.2%;The drug resistance rate of newly treated patients was 29.3%,and that of re treated patients was68.4%;The drug resistance rate of retreated patients is much higher than that of newly treated patients.Before initial treatment,timely detection of drug resistance should be carried out to reduce the incidence of drug resistance and improve treatment effectiveness.It is suggested that clinical practice should adjust the patient’s medication plan as soon as possible based on the drug resistance situation,urge patients to take medication,and minimize the occurrence of recurrent cases.4.The Beijing type strain is still the most widely prevalent strain in this region,and no association between genotype and drug resistance has been found.The main mutation in INH resistance is the S315T mutation in the kat G gene;The mutations in RFP resistance genes all occur in the rifampicin resistance determining region,with the rpo B gene L533P being the main mutation;The main type of EMB resistance mutation is the emb B gene M306I;The mutation types of SM resistance are all rps L gene K88R;The main type of FQs resistance mutation is the gyr A gene D94G. |
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