Pretreatment HIV drug resistance in adults initiating antiretroviral therapy in China, 2017

Rui-Hua Kang,Lin Xiao,Yan-Ling Ma,Shu Liang,Hui Xing,Jian-Mei He,Yi-Ming Shao,Ling-Jie Liao,Xin-Hui Zhang,Hong-Yan Lu,Xiao-Qin Xu,Yu-Hua Ruan,Guo-Hui Wu,Shu-Jia Liang,Shui-Bin Luo,Lin Chen,Xiao-Guang Sun

doi:10.1186/s40249-020-00668-5

Abstract

BackgroundAfter the scale-up of antiretroviral therapy (ART) for HIV infected people, increasing numbers of patients have pretreatment drug resistance (PDR). In this study, the prevalence of PDR was evaluated in adults initiating antiretroviral therapy in China.MethodsBlood samples were obtained from 1943 patients who initiated antiretroviral therapy (ART) in 2017 from 13 provinces or cities in China. Pol sequences were used to analyze drug resistance and construct transmission networks. Logistic regression model was used to estimate the potential factors associated with PDR.ResultsIn total, 1711 eligible patients (76.0% male; 87.8% aged ≥ 25 years) were included, of which 117 (6.8%) had PDR. The highest rates of PDR were 12.2% in Liangshan Prefecture of Sichuan and 9.3 and 8.9% in Dehong and Lincang Prefecture of Yunnan. A multivariate logistic regression analysis revealed that PDR was significantly higher among intravenous drug users (adjusted Odds Ratio (aOR) = 2.64, 95% CI: 1.57–4.44) and individuals from Liangshan, Dehong, and Lincang (aOR = 2.04, 95% CI: 1.26–3.30). In total, 754 sequences were used to generate 164 transmission networks. Five transmission networks had two or three sequences containing the same mutations, two networks contained subjects from Liangshan, and one network contained subjects from Dehong.ConclusionsOverall, the PDR prevalence was moderate, with a particularly high prevalence in areas with severe HIV epidemics. These results indicate the importance of continuous PDR monitoring in patients initiating antiretroviral therapy.

Highlights

After the scale-up of antiretroviral therapy (ART) for Human immunodeficiency virus (HIV) infected people, increasing numbers of patients have pretreatment drug resistance (PDR)
If the prevalence of PDR to non-nucleoside reverse-transcriptase inhibitors (NNRTIs) is ≥10% among individuals initiating first-line ART, excluding those with previous antiretroviral drug exposure, an alternative first-line ART regimen as a supplement should be urgently considered in accordance with the consolidated guidelines on the use of antiretroviral drugs established in 2016 [13]
Twenty participants were excluded, including fourteen participants who were aged below 18 years and six without any information

Summary

Introduction

After the scale-up of antiretroviral therapy (ART) for HIV infected people, increasing numbers of patients have pretreatment drug resistance (PDR). The prevalence of PDR was evaluated in adults initiating antiretroviral therapy in China. Active antiretroviral therapy has decreased mortality rates and prolonged the lives of people living with HIV or AIDS (PLWHA) [1,2,3,4]. With the NFATP development and the formulation of the UNAIDS targets of “90–90-90” by 2020 [5], and the most important to improve the quality of life for PLWHA, the number of people receiving antiretroviral therapy (ART) has increased. Individuals infected with drug-resistant HIV strains may experience early virological failure [6,7,8], and the accumulation and transmission of drug-resistant strains can result in an increased mortality rate. If the prevalence of PDR to non-nucleoside reverse-transcriptase inhibitors (NNRTIs) is ≥10% among individuals initiating first-line ART, excluding those with previous antiretroviral drug exposure, an alternative first-line ART regimen as a supplement should be urgently considered in accordance with the consolidated guidelines on the use of antiretroviral drugs established in 2016 [13]

Methods

Results

Discussion

Conclusion