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ORIGINAL RESEARCH article

Front. Public Health

Sec. Infectious Diseases: Epidemiology and Prevention

Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1550121

Prevalence and transmission of HIV-1 drug resistance mutations among patients with treatment failure and newly diagnosed people in Liangshan Prefecture, China, in 2021-2023

Provisionally accepted
Rong Pei Rong Pei 1,2Chunnong Jike Chunnong Jike 3Gang Yu Gang Yu 3Ling Su Ling Su 4Ju Wang Ju Wang 3Lin Xiao Lin Xiao 3Yubing Wang Yubing Wang 3Maogang Shen Maogang Shen 3Jiayi Liao Jiayi Liao 2Yulian Zhang Yulian Zhang 2Yifei Zheng Yifei Zheng 2Joris Hemelaar Joris Hemelaar 1*
  • 1 University of Oxford, Oxford, United Kingdom
  • 2 Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
  • 3 Liangshan Prefecture Center for Disease Control and Prevention, Xichang, Sichuan, China
  • 4 Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan Province, China

The final, formatted version of the article will be published soon.

    Despite expanded antiretroviral therapy (ART) in China, HIV transmission persists. Liangshan Prefecture is one of the areas in China most severely affected by HIV, with high levels of drug resistance. A deeper understanding of HIV-1 drug resistance can lead to improvements in current treatment policies. We conducted an analysis of HIV drug resistance mutations (DRMs) among patients with treatment failure and people newly diagnosed with HIV in Liangshan Prefecture. 8,523 blood samples were collected from people living with HIV with treatment failure and newly diagnosed individuals in all 15 counties and two cities in Liangshan Prefecture between 2021 and 2023. 43.0% of patients with treatment failure acquired HIV through the heterosexual route, followed by injecting drug use (38.7%), while newly diagnosed individuals mainly acquired HIV through the heterosexual route (86.7%). 95.6% of patients with treatment failure were infected with HIV-1 variant CRF07_BC and 2.7% with CRF08_BC, and newly diagnosed individuals were also main infected with HIV-1 variant CRF07_BC (90.9), followed by CRF08_BC (4.0%) and CRF01_AE (2.5%). The overall prevalence of acquired drug resistance (ADR) among patients with treatment failure was 57.4%. The overall prevalence of pre-treatment drug resistance (PDR) among newly diagnosed individuals was 23.9%. A high prevalence of ADR and PDR (especially high-level resistance) to efavirenz (48.0% vs. 11.1%) and nevirapine (49.6% vs. 11.4%) was found. The main non-nucleoside reverse transcriptase inhibitor (NNRTI)-associated ADR and PDR mutations were K103, V106, and V179. Our findings highlight age <18 years, injecting drug use, and initiation on NNRTI-based regimen as independent risk factors for HIV ADR development. We found minor variants as a risk factor for PDR, and CRF01_AE was associated with a higher risk than CRF07_BC for nucleoside reverse transcriptase inhibitor (NRTI) PDR. Given the high levels of NNRTI ADR and PDR, future clinical treatment plans should minimize the use of NNRTI-based regimens and should instead adopt alternative ART regimens more frequently.

    Keywords: HIV-1, Treatment Failure, Drug Resistance, subtype, antiretroviral therapy

    Received: 22 Dec 2024; Accepted: 13 Feb 2025.

    Copyright: © 2025 Pei, Jike, Yu, Su, Wang, Xiao, Wang, Shen, Liao, Zhang, Zheng and Hemelaar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Joris Hemelaar, University of Oxford, Oxford, United Kingdom

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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