Prevalence and Molecular Epidemiology of Transmitted Drug Resistance and Genetic Transmission Networks Among Newly Diagnosed People Living With HIV/AIDS in a Minority Area, China.

Dan Yuan,Meijing Liu,Yiping Li,Maogang Chen,Linglin Zhang,Zixin Wang,Li Ye,Shu Liang,Laze Api,Bin Yu,Ling Su,Li Liu,Chang Zhou,Yan Zhang,Peng Jia,Yuling Huang,Shujuan Yang

doi:10.3389/fpubh.2021.731280

Abstract

Introduction: Transmitted drug resistance (TDR) can compromise antiretroviral therapy (ART) efficacy. We aimed to understand the molecular epidemiology of TDR and its genetic transmission networks among newly diagnosed people living with HIV/AIDS (PLWH).Methods: A total of 1,318 newly diagnosed PLWH, identified in all population-based HIV screening in an HIV-affected county of a minority area of China (i.e., Butuo county), were enrolled between January 1, 2018, and November 31, 2018. HIV-1 pol gene sequences were used for phylogenetic and genotypic drug resistance analyses. The genetic transmission networks were identified.Results: The prevalence of TDR among newly diagnosed PLWH was 8.12% (107/1,318). Patients in the stage of AIDS (adjusted odds ratio, OR: 2.32) and who had a history of sharing a needle ≥5 times (adjusted OR: 3.89) were more likely to have an increased risk of TDR. The prevalence of TDR for non-nucleoside reverse transcriptase inhibitors (NNRTIs) is higher than that of other inhibitors, with a relatively high prevalence of three mutations [V179D/E/DE (4.93%), K103N/KN (3.11%), and E138A/G (1.52%)]. A total of 577 (43.78%) pol sequences were involved in the genetic transmission network, with 171 clusters ranging in size from 2 to 91 pol sequences; 37.38% (40/107) of individuals carrying TDR were involved in the network, and individuals with the same TDR-associated mutations were usually cross-linked.Conclusions: Our data suggest a relatively high level of TDR and many transmission clusters among the newly diagnosed PLWH. Targeted intervention, early identification, and monitoring of resistance are warranted to reduce the TDR and prevent HIV-1 transmission in areas with a high rate of HIV-1.

Highlights

Transmitted drug resistance (TDR) can compromise antiretroviral therapy (ART) efficacy
In the multivariate logistic regression model, we found that participants who were in the stage of Acquired Immune Deficiency Syndrome (AIDS) and had a history of sharing a needle ≥5 times were more likely to have an increased risk of TDR among newly diagnosed people living with HIV/AIDS (PLWH) (P < 0.05) (Table 1)
37.38% (40/107) of individuals carrying TDR were involved in the network, and K103N (42.5%, 17/40) was the most frequent TDR-associated mutation, followed by E138A (15%, 6/40), I54M (7.5%, 3/40), and Q58E (7.5%, 3/40)

Summary

Introduction

Transmitted drug resistance (TDR) can compromise antiretroviral therapy (ART) efficacy. The human immunodeficiency virus affected more than 37 million individuals worldwide, and there were approximately 0.85 million people living with HIV/AIDS (PLWH) in China as of 2018. Antiretroviral therapy (ART) is effective in suppressing HIV, preventing the disease progression, and secondary HIV transmission [4, 5]. TDR occurs when previously uninfected individuals are infected with drug-resistant HIV strains, and TDR is detected in PLWH with no history of antiretroviral drug exposure [8]. Severe TDR is likely to occur in non-recently contaminated patients [9, 10], and the policy of treating all PLWH decreases the risk of transmission of resistant strains. TDR may increase the risk of virologic failure on ART and lead to the spread of drug-resistant strains, bringing a challenge in eliminating HIV. TDR should be an intensive focus in HIV surveillance to prevent the spread of drug-resistant strains

Objectives

Methods

Results

Conclusion