HIV-1 drug resistance and associated risk factors in patients with antiretroviral therapy failure in Chongqing, China, 2019–2023

Our study reveals a high prevalence of HIV-1 drug resistance among patients with treatment failure in Chongqing, with low baseline CD4 + T-cell counts and NNRTI-based initial regimens identified as key risk factors. These findings underscore the urgency of optimizing first-line therapy by prioritizing dolutegravir (DTG)-based regimens, with protease inhibitor (PI)-based regimens as a practical alternative. Furthermore, we recommend implementing timely genotypic resistance testing, ideally within 4 weeks upon confirmed virologic failure, to guide effective regimen switching and curb the spread of drug resistance.