HIV drug resistance and HIV transmission risk factors among newly diagnosed individuals in Southwest China

Xianwu Pang,Kailing Tang,Qin He,Xiuling Wu,Zhiyong Shen,Ningye Fang,Shujia Liang,Xinjuan Zhou,Jinghua Huang,Qiuying Zhu

doi:10.1186/s12879-021-05854-w

Abstract

BackgroundThe widespread use of antiretroviral therapy (ART) has resulted in the development of transmitted drug resistance (TDR), which reduces ART efficacy. We explored TDR prevalence and its associated risk factors in newly diagnosed individuals in Guangxi.MethodsWe enrolled 1324 participants who were newly diagnosed with HIV-1 and had not received ART at voluntary counselling and testing centres (VCT) in Guangxi, China, who had not received ART. Phylogenetic relationship, transmission cluster, and genotypic drug resistance analyses were performed using HIV-1 pol sequences. We analysed the association of demographic and virological factors with TDR.ResultsIn total, 1151 sequences were sequenced successfully, of which 83 (7.21%) showed evidence of TDR. Multivariate logistic regression analysis revealed that there was significant difference between the prevalence of TDR and unmarried status (adjusted odds ratio (aOR) = 2.41, 95% CI: 1.23–4.71), and CRF08_BC subtype (aOR = 2.03, 95% CI: 1.13–3.64). Most cases of TDR were related to resistance to non-nucleoside reverse transcriptase inhibitors (4.87%) and V179E was the most common mutation detected. We identified a total of 119 HIV transmission clusters (n = 585, 50.8%), of which 18 (15.1%) clusters showed evidence of TDR (36, 41.86%). Three clusters were identified that included drug-resistant individuals having a transmission relationship with each other. The following parameters were associated with TDR transmission risk: Unmarried status, educational level of junior high school or below, and CRF08_BC subtype may be a risk of the transmission of TDR.ConclusionsOur findings indicated that moderate TDR prevalence and highlighted the importance of continuous TDR monitoring and designing of strategies for TDR mitigation.

Highlights

The widespread use of antiretroviral therapy (ART) has resulted in the development of transmitted drug resistance (TDR), which reduces ART efficacy
Drug resistance analysis We evaluated clinically relevant resistance to nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), or protease inhibitors (PIs) using the Stanford University Human immunodeficiency virus (HIV) Drug Resistance Database Genotypic Resistance Interpretation Algorithm and the International Antiviral Society Drug Resistance Mutation list [16]
Logistic regression analysis was performed to identify risk factors associated with TDR

Summary

Introduction

The widespread use of antiretroviral therapy (ART) has resulted in the development of transmitted drug resistance (TDR), which reduces ART efficacy. We explored TDR prevalence and its associated risk factors in newly diagnosed individuals in Guangxi. Guangxi is located in Southwest China, adjacent to Vietnam and the Yunnan and Guangdong provinces. It is one of the areas in China that is most heavily affected by the human immunodeficiency virus 1 (HIV-1) in China [1]. By the end of 2017, Guangxi has the second highest number of reported HIV cases (113,500) in the country [3]. The increase in ART access corresponds to an increase in HIV drug resistance, which can be transmitted to newly infected individuals. More recently, the prevalence of TDR been reported to increase to 12.2% in Tianjin [15], 17.4% in Shanghai [16], and 6.12% in Beijing [17]

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