由传播而获得的原发耐药（传播耐药，TDR）是HIV初始抗病毒治疗失败的主要原因，但临床上常有TDR阴性感染者发生治疗失败现象。前期研究提示：TDR在传播到新宿主后会向野毒株反转（回复突变），但仍留有低水平的劣势耐药株持续复制，造成常规方法漏检，导致治疗失败。为进一步了解北京地区常见TDR的演变特点及其对抗病毒治疗的影响，本课题拟在我院建立的男男性接触人群随访队列中筛查携带TDR的HIV急性/近期感染者，对其治疗前的系列血标本进行TDR动态检测和量化分析，力求阐明TDR在自然免疫压力下的基因演变特征；通过病毒准种基因进化分析，探讨病毒亚型、野毒株共感染、准种间基因离散率等因素对TDR演变的影响；并对部分TDR阴性治疗成功和失败患者的基线标本进行劣势耐药株检测，分析其对抗病毒治疗的影响。本研究旨在揭示TDR病毒株的演变规律，为原发耐药检测策略的制定及临床合理选择初始抗病毒治疗方案提供理论依据。

Transmitted drug resistance (TDR) is the main reason for the failure of initial antiretroviral therapy (ART).But failure of ART is not uncommon in TDR negative patients, which always make clinicians confused. Our previous studies hint that, after TDR transmitted to the new host, they can reverse to wild strains but will persist in the form of low-level replication (Minority Variants of Drug-Resistant HIV, Minority Variants). These Minority Variants usually are undetectable by conventional methods (bulk population sequencing) resulting in increased failure rate ART in the future. However, there are very few studies focused on the evolution of TDR due to the difficulty of identifying patients in acute infection period. The present study intends to screen TDR among 50 patients with acute or recent HIV infection diagnosed from a MSM cohort, detect TDR in their 0-48 month series of plasma samples, summarize the gene evolution characteristics of various resistance mutations; By the analysis of gene evolution of virus quasispecies, exploring the possible influence of other genetic factors, such as virus subtype, wild virus co-infection, quasi genetic divergence, et al ; Plasma samples of patients with treatment success and patients with treatment failure will be analyzed by HTS to look for the prevalence of Minor Variants among primary infected patients, and explore the correlation between these Minority Variants and the treatment failure. The aims of this study are to investigate the evolution characteristics of TDR and its effect on the primary antiviral therapy ,to provide a theoretical basis for developing strategies to combat primary drug resistance and the proper selection of clinical antiretroviral regimen.