Pre-treatment and Acquired Antiretroviral Drug Resistance among People Living with HIV in Southwest China

Background The prevalence and epidemiology of pre-treatment drug resistance (PDR) and acquired drug resistance (ADR) among HIV-infected individuals vary considerably in different regions of China. Both types of drug resistance have adverse effects on the antiviral treatment outcomes for patients, potentially exacerbating their poor prognosis. Currently, there is a paucity of research on the prevalence and epidemiology of PDR and ADR among HIV-infected individuals in Southwest China. Objective This study investigated the prevalence and epidemiology of pre-treatment drug resistance and acquired drug resistance among people living with HIV (PLWH) in Southwest China. Methods This was a large cross-sectional study that enrolled PLWH who visited Guiyang Public Health Clinical Center between January 1, 2021, and June 30, 2023, and underwent drug resistance gene testing. HIV-1 genotype and drug resistance were analyzed using HIV-1 pol sequence. The Stanford University HIV Drug Resistance Database was used to analyze major drug resistance mutations in the reverse transcriptase and protease Sanger sequences. Risk factors associated with pre-treatment drug resistance were evaluated using a Logistic regression model. Results A total of 1 613 individuals were included in the study, with 824 ART-naive and 789 ART-experienced. The most common genotype among ART-naive patients was B+C (47.0%), and the drug resistance rate was 18.7% (154/824) with non-nucleoside reverse transcriptase inhibitors (NNRTIs) accounting for 14.9% (123/824), nucleoside reverse transcriptase inhibitors (NRTIs) accounting for 1.7% (14/824), protease inhibitors (PIs) accounting for 2.7% (22/824), and integrase strand transfer inhibitors (INSTIs) accounting for 1.9% (16/824). Among the ART-experienced patients, the most common genotype was CRF01-AE (37.4%), with a drug resistance rate of 27.8% (219/789). The mutation rates for NNRTIs, NRTIs, PIs, and INSTIs were 7.7% (61/789), 19.3% (152/789), 2.7% (21/789), and 1.1% (9/789), respectively. Furthermore, multivariate Logistic regression modeling revealed that transmission route, CD4+ T-cell count, viral load, and the time interval between diagnosis and ART initiation were associated with an increased risk of pre-treatment drug resistance (P<0.05) . Conclusion The incidence of pre-treatment drug resistance and acquired drug resistance mutations among PLWH in Southwest China is relatively high, 18.7% and 27.8% respectively. Transmission route, CD4+ T-cell count, viral load, and the time interval between diagnosis and ART initiation are associated with an increased risk of pretreatment drug resistance. Therefore, to prevent the development of resistance, there is an urgent need for routine baseline genotypic resistance testing and adequate intervals for viral load monitoring.