Pre-treatment and acquired HIV drug resistance in Hunan: a cross-sectional analysis of a growing challenge

HIV Drug Resistance (HIVDR) is a key consideration when determining ART regimens. In recent years, Pre-treatment Drug Resistance (PDR) and Acquired Drug Resistance (ADR) have been changing rapidly. We studied the latest PDR and ADR cases in Hunan Province, China. The study included People Living With HIV (PLWH) from a hospital in Hunan Province (May 2021–August 2023). Baseline characterisation data were collected from participants. HIV-1 pol sequences were amplified, sequenced, and analyzed for DR mutations, which were analyzed using the Stanford University HIVDR database. Descriptive analysis was used for statistical descriptions. 1,314 PLWH (1,277 successfully tested) were included in the study. Among 917 treatment-naïve PLWH, the most prevalent subtypes were CRF07_BC (41.8%) and CRF01_AE (38.4%), PDR was 14.7% (135/917), with NNRTIs DR rate at 11.6%(mainly NVP 11.6%, EFV 11.1%, RPV 6.7%), NRTIs at 3.6% (mainly ABC 3.4%, 3TC/FTC 3.3%, DDI 1.6%), while INSTIs and PIs remained ≤ 1.1%, NNRTIs mutations were most prevalent in V170D/E/L(5.1%) and K238N(3.2%), NRTIs were t in M184I/V(3.3%) and K70E/N/Q/R(0.5%), INSTIs/ PIs were ≤ 0.7%. Among 360 treatment-failure PLWH, the most prevalent subtypes were CRF01_AE (43.1%) and CRF07_BC (26.4%), ADR reached 67.2% (242/360), and NNRTIs DR rate was 54.7%(mainly NVP 54.2%, EFV 52.5%, RPV 38.3%) and NRTIs was 38.1%(mainly 3TC 35.3%, ABC 35.0%, FTC 34.4%,). INSTIs and PIs were ≤ 4.2%, NNRTIs mutations were most prevalent in V170D/E/Q/I/T(20.0%) and K103N/T/R/S(16.9%), NRTIs were in M184I/V(30.8%) and K65R(12.5%), INSTIs/PIs were ≤ 3.3%. Both HIV-1 PDR and ADR were challenged in Hunan Province, China. DR testing should be conducted before selecting an ART regimen to guide the initial regimen or develop a more precise regimen. For PLWH who fail to complete DR testing, choosing a regimen containing PIs or INSTIs with a high resistance barrier is more advisable.