Abstract
BackgroundTransmitted drug resistance (TDR) reduces the efficacy of initial antiretroviral treatment and has become a public health concern. Little information is available regarding the genetic diversity of HIV-1 and the prevalence of TDR among treatment-naïve patients in a northwestern province of China since the implementation of national free antiretroviral therapy (ART).MethodsBlood samples from 372 HIV-1 treatment-naive patients were collected between 2003 and 2013 in Shaanxi province. Viral RNA was extracted for nested PCR, and phylogenetic reconstruction and recombination analyses were performed to characterize patterns of the HIV-1 subtypes. Genotypic drug resistance testing was performed using an in-house assay to determine trends in the prevalence of HIV-1 transmitted drug resistance.ResultsMultiple genotypes were identified among the patients in Shaanxi, including B (25.0%), C (0.3%), G (0.3%), and CRF01_AE (39.2%), CRF07_BC (32.7%), CRF08_BC (0.8%), CRF55_01B (1.1%), and URFs (0.6%). The subtypes were associated with the transmission routes (χ2 = 77.113, p<0.01). In this study, a low baseline CD4+ T cell count and a high viral load were found among CRF01_AE-infected patients compared with patients who were infected with non-CRF01_AE (p<0.01) through sexual transmission; however, the CRF01_AE subtype was not associated with a low baseline CD4+ T cell count or a high viral load in Chinese patients infected through blood transmission (p = 0.249). The overall TDR rate in this population was 4.4% between 2003 and 2013. A univariate logistic regression model revealed that a low CD4 T cell count (≤100 cells/µL) was associated with the development of drug-resistant strains.ConclusionOur work revealed diverse HIV-1 subtype distributions in Shaanxi province. We identified a low and stable TDR time trend among ART-naive patients. These findings enhance our understanding of HIV-1 genetic diversity and provide some guidelines for the improvement and implementation of a comprehensive public health strategy of HIV-1 TDR prevention.
Highlights
Active antiretroviral therapy (HAART) has dramatically decreased the morbidity and mortality caused by HIV-1
According to the 2013 UNAIDS report, an estimated 35.3 million people were infected with HIV globally in 2012
The department of infectious diseases in Tangdu hospital is the main HIV/AIDS clinic in Shaanxi province. This clinic is responsible for HIV intervention and prevention programs, and provides free ART with care in Shaanxi province
Summary
Active antiretroviral therapy (HAART) has dramatically decreased the morbidity and mortality caused by HIV-1. The number of AIDS deaths is declining, with 1.6 (1.4–1.9) million deaths in 2012, down from 2.3 (2.1–2.6) million deaths in 2005 [1]. Despite these achievements, HAART is not able to eliminate infected cells, and plasma viremia generally rebounds quickly after treatment is discontinued [2,3]. Transmitted drug resistance (TDR) reduces the efficacy of initial antiretroviral treatment and has become a public health concern. Little information is available regarding the genetic diversity of HIV-1 and the prevalence of TDR among treatment-naıve patients in a northwestern province of China since the implementation of national free antiretroviral therapy (ART)
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