National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China.
BMC Infect Dis. 2021 Nov 12;21(1):1153. doi: 10.1186/s12879-021-06847-5.
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-positive individuals that initiated antiretroviral therapy in 2014-2020 in southwestern China.
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 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.
In total, 3236 eligible HIV-positive individuals were included. The overall prevalence of PDR was 6.0% (194/3236). The PDR frequency to NNRTI (3.3%) was much higher than that of NRTI (1.7%, p < 0.001) and PI (1.2%, p < 0.001). 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 harboring 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 had the same drug resistant mutations (DRMs), mostly to NNRTIs (50%, 5/10).
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.
预处理耐药（PDR）会限制 HIV 抗逆转录病毒治疗（ART）的效果。本研究旨在评估 2014-2020 年在中国西南部开始接受抗逆转录病毒治疗的 HIV 阳性个体中 PDR 的流行率。
本研究在广西钦州市进行了连续的横断面调查。我们从 2014-2020 年新诊断出 HIV 的个体中采集了血样。通过使用斯坦福 HIV 数据库算法和 HIV-TRACE 对 HIV-1 pol 序列进行 PDR 和遗传网络分析。采用单变量和多变量逻辑回归模型探讨与 PDR 相关的潜在因素。
共纳入 3236 名符合条件的 HIV 阳性个体。总的 PDR 流行率为 6.0%（194/3236）。NNRTI 的 PDR 频率（3.3%）明显高于 NRTI（1.7%，p<0.001）和 PI（1.2%，p<0.001）。多变量逻辑回归分析显示，18-29 岁（调整后的优势比（aOR）：1.79，95%可信区间（CI）：1.28-2.50）或 30-49 岁（aOR：2.82，95%CI：1.73-4.82）的个体和携带 CRF08_BC（aOR：3.23，95%CI：1.58-6.59）的个体 PDR 显著更高。共形成 1429 个（43.8%）序列的传播簇，大小从 2 到 119 个个体不等。10 个簇中有 22 个个体具有相同的耐药突变（DRMs），主要是对 NNRTIs（50%，5/10）。
总的来说，PDR 的流行率处于中等水平，网络中具有遗传联系的个体中存在大量相同的 DRMs 进一步说明了监测研究对于减轻 PDR 的重要性。
