Survey of pretreatment HIV drug resistance and the genetic transmission networks among HIV-positive individuals in southwestern China, 2014\u20132020

Xiaoshan Xu,Lingjie Liao,Qiuying Zhu,Zhiyong Shen,Chang Song,Huanhuan Chen,Jianjun Li,Yiming Shao,Yi Feng,Liuhong Luo,Yuhua Ruan,Shujia Liang,Guanghua Lan,Hui Xing,Zhiqiang Cao

doi:10.1186/s12879-021-06847-5

Xiaoshan Xu, Lingjie Liao + Show 13 more

Open Access

https://doi.org/10.1186/s12879-021-06847-5

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Abstract

BackgroundPretreatment drug resistance (PDR) can limit the effectiveness of HIV antiretroviral therapy (ART). The aim of this study was to assess the prevalence of PDR among HIV-positive individuals that initiated antiretroviral therapy in 2014–2020 in southwestern China.MethodsConsecutive cross-sectional surveys were conducted in Qinzhou, Guangxi. We obtained blood samples from individuals who were newly diagnosed with HIV in 2014–2020. PDR and genetic networks analyses were performed by HIV-1 pol sequences using the Stanford HIV-database algorithm and HIV-TRACE, respectively. Univariate and multivariate logistic regression models were used to explore the potential factors associated with PDR.ResultsIn total, 3236 eligible HIV-positive individuals were included. The overall prevalence of PDR was 6.0% (194/3236). The PDR frequency to NNRTI (3.3%) was much higher than that of NRTI (1.7%, p < 0.001) and PI (1.2%, p < 0.001). A multivariate logistic regression analysis revealed that PDR was significantly higher among individuals aged 18–29 (adjusted odds ratio (aOR): 1.79, 95% CI 1.28–2.50) or 30–49 (aOR: 2.82, 95% CI 1.73–4.82), and harboring CRF08_BC (aOR: 3.23, 95% CI 1.58–6.59). A total of 1429 (43.8%) sequences were linked forming transmission clusters ranging in size from 2 to 119 individuals. Twenty-two individuals in 10 clusters had the same drug resistant mutations (DRMs), mostly to NNRTIs (50%, 5/10).ConclusionsThe overall prevalence of PDR was medium, numerous cases of the same DRMs among genetically linked individuals in networks further illustrated the importance of surveillance studies for mitigating PDR.

Highlights

Pretreatment drug resistance (PDR) can limit the effectiveness of Human immunodeficiency virus (HIV) antiretroviral therapy (ART)
It formulated the monitoring of drug resistant people who initiated antiretroviral therapy [3], which was recommended to monitor HIV resistance levels and factors associated with HIV drug resistance
According to the consolidated guidelines on the use of antiretroviral drugs, the proportion of Non-nucleoside reverse-transcriptase inhibitor (NNRTI) resistance is much higher than that of Nucleoside reverse-transcriptase inhibitor (NRTI) and Protease inhibitor (PI) in countries with NNRTIs-based first-line treatment, and if the percent of HIV-positive individuals harboring NNRTI resistance reaches above 10%, first-line treatments would need to be modified in these settings [13]

Summary

Introduction

Pretreatment drug resistance (PDR) can limit the effectiveness of HIV antiretroviral therapy (ART). The aim of this study was to assess the prevalence of PDR among HIV-positive individuals that initiated antiretroviral therapy in 2014–2020 in southwestern China. To address the challenges posed by drug-resistant viruses, WHO formulated a global strategy for the prevention of HIV drug resistance in 2012 [5]. It formulated the monitoring of drug resistant people who initiated antiretroviral therapy [3], which was recommended to monitor HIV resistance levels and factors associated with HIV drug resistance. According to the consolidated guidelines on the use of antiretroviral drugs, the proportion of NNRTIs resistance is much higher than that of NRTIs and PIs in countries with NNRTIs-based first-line treatment, and if the percent of HIV-positive individuals harboring NNRTI resistance reaches above 10%, first-line treatments would need to be modified in these settings [13]

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