Survey of Pretreatment HIV Drug Resistance and The Genetic Transmission Networks Among HIV-Infected Individuals in Southwestern China, 2014-2020
Abstract Background 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-infected individuals that initiated antiretroviral therapy in 2014–2020 in southwestern China. Methods Consecutive 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 by 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. Results In total, 3236 eligible patients were included. The overall prevalence of PDR was 6.0% (194/3236). The PDR frequency to NNRTI (3.3%) was much higher than that to NRTI (1.7%) and PI (1.2%) (p < 0.0001). 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 infected with 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 same drug resistant mutations (DRMs), mostly to NNRTIs (50%, 5/10). Conclusions The 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.