HIV-1 drug resistance and associated risk factors in antiretroviral therapy failure: a 2022–2024 surveillance in Huzhou, China

Introduction Characterizing acquired drug resistance (ADR) profiles among individuals experiencing antiretroviral therapy (ART) failure is critical for optimizing clinical management. Methods This study aimed to delineate the HIV-1 drug resistance landscape, specific resistance-associated mutations, and epidemiological determinants in Huzhou, China, from 2022 to 2024. Blood samples and epidemiological data were collected from 184 HIV-1-infected patients experiencing ART failure. Viral pol region sequences were amplified, and drug resistance mutations (DRMs) were interpreted using the Stanford University HIV Drug Resistance Database. Results The overall prevalence of ADR was 44.0% (81/184). Resistance to protease inhibitors (PIs) remained notably low at 1.6%,whereas the prevalence of DRMs associated with nucleoside (NRTIs) and non nucleoside reverse transcriptase inhibitors (NNRTIs) reached 27.7% and 41.8%, respectively. The most frequently detected NRTI-associated DRMs included M184V/I and K65R, while dominant NNRTI-associated mutations comprised V179D/E/F, K103N, V106I/L/M, G190A/Q/S/T, and Y181C/L. Furthermore, multivariable logistic regression identified patient age, plasma viral load, and specific HIV-1 subtypes as independent risk factors for DRM development. Discussion Ultimately, this study elucidates the evolving mutational landscape among ART-experienced individuals, providing critical evidence-based insights for optimizing personalized antiretroviral regimens and mitigating the onward transmission of drug-resistant HIV-1 variants within the region.