Abstract

BackgroundGenetic variability and liability to develop drug-resistant mutations are the main characteristics of HIV-1, which can not only increase the risk of antiretroviral treatment (ART) failure, but also can lead to the spread of resistant strains. We aim to investigate the distribution of HIV-1 genotypes and prevalence of pretreatment drug resistance (PDR) in ART-naïve HIV-1 infected patients in Shanghai China.MethodsA cross-sectional study was performed among the newly diagnosed ART-naive HIV-1 infected patients during the period from January 2017 to November 2017 in Shanghai Public Health Clinical Center. The target fragment of 1316 bp in the pol gene spanning the reverse transcriptase and protease regions was amplified using a nested polymerase chain reaction. HIV-1 genotypes were determined by phylogenetic analysis, and PDR associated mutations were determined according to Stanford University HIV Drug Resistance Database (http://hivdb.stanford.edu/).ResultsWe successfully amplified pol gene sequences from blood samples of 317 patients, of whom 95.3% were male, and 68.8% were men who have sex with men. The median age was 33 years; and the median CD4 count was 275 cells/μL. The predominant HIV-1 genotype was circulating recombinant form (CRF) 01_AE (53.0%, 168/317), followed by CRF07_BC (29.7%, 94/317), B (7.6%, 24/317), CRF08_BC (1.9%, 6/317), CRF55_01B (1.9%, 6/317), CRF 59_01B (0.9%, 3/317). In addition, 5% (16/317) HIV-1 strains were identified as other subtypes or CRFs/URFs (unique recombinant forms). The overall prevalence of PDR was 17.4% (55/317). PDR frequency to non-nucleoside reverse transcriptase inhibitor (NNRTI, 16.4%) was much higher than that to nucleoside reverse transcriptase inhibitor (NRTI, 4.7%) and protease inhibitor (PI, 0.6%). The most common HIV-1 mutation pattern for NNRTI and NRTI were V179D/E (10.1%, 32/317) and M184 V (2.8%, 9/317), respectively. About half (49.1%, 27/55) of the HIV-1 strains with mutation presented as potential low-level resistant to NNRTI attributed to V179D/E.ConclusionThe distribution of HIV-1 genotypes in Shanghai China is diverse and complex. The high prevalence of PDR highlights the significance of baseline HIV-1 drug resistance testing. Non-NNRTI-containing regimen may be the preferred initial therapy for newly diagnosed HIV-1 patients in Shanghai in the absence of PDR test results.

Highlights

  • Genetic variability and liability to develop drug-resistant mutations are the main characteristics of HIV type 1 (HIV-1), which can increase the risk of antiretroviral treatment (ART) failure, and can lead to the spread of resistant strains

  • Demographic and clinical characteristics of the participants A total of 338 HIV-1 infected patients were enrolled in the study, and pol gene sequences were successfully amplified and analyzed from the plasma samples of 317 participants, including 302 (95.3%) male and 15 (4.7%) female

  • There were no significant differences in age, sex, marital status, self-reported risk factor for HIV-1 infection, and CD4 counts among the groups divided by HIV-1 genotypes (Table 2)

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Summary

Introduction

Genetic variability and liability to develop drug-resistant mutations are the main characteristics of HIV-1, which can increase the risk of antiretroviral treatment (ART) failure, and can lead to the spread of resistant strains. We aim to investigate the distribution of HIV-1 genotypes and prevalence of pretreatment drug resistance (PDR) in ART-naïve HIV-1 infected patients in Shanghai China. HIV/AIDS remains a major public health problem in China. The main characteristics of HIV are its enormous genetic variability and liability to develop drug-resistant mutations along with high rates of virus replication. With the development of social economy and the rapid growth of migrants, the distribution of HIV-1 genotypes may have become more diverse and complex due to HIV-1 population movements and the ongoing recombination between different HIV-1 subtypes

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