National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.
Sichuan Nursing Vocational College, Chengdu, China.
JMIR Public Health Surveill. 2023 Nov 17;9:e50894. doi: 10.2196/50894.
Emerging HIV drug resistance caused by increased usage of antiretroviral drugs (ARV) could jeopardize the success of standardized HIV management protocols in resource-limited settings.
We aimed to characterize pretreatment HIV drug resistance (PDR) among HIV-positive individuals and risk factors in China in 2022.
This cross-sectional study was conducted using 2-stage systematic sampling according to the World Health Organization's surveillance guidelines in 8 provincial-level administrative divisions in 2022. Demographic information and plasma samples were obtained from study participants. PDR was analyzed using the Stanford HIV drug resistance database, and the Tamura-Nei 93 model in HIV-TRACE was used to calculate pairwise matches with a genetic distance of 0.01 substitutions per site. Logistic regression was used to identify and estimate factors associated with PDR.
PDR testing was conducted on 2568 participants in 2022. Of the participants, 34.8% (n=893) were aged 30-49 years, 81.4% (n=2091) were male, and 3.2% (n=81) had prior ARV exposure. The prevalence of PDR to protease and reverse transcriptase regions, nonnucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors, and protease inhibitors were 7.4% (n=190), 6.3% (n=163), 1.2% (n=32), and 0.2% (n=5), respectively. Yunnan, Jilin, and Zhejiang had much higher PDR incidence than did Sichuan. The prevalence of nonnucleoside reverse transcriptase inhibitor-related drug resistance was 6.1% (n=157) for efavirenz and 6.3% (n=163) for nevirapine. Multivariable logistic regression models indicated that participants who had prior ARV exposure (odds ratio [OR] 7.45, 95% CI 4.50-12.34) and the CRF55_01B HIV subtype (OR 2.61, 95% CI 1.41-4.83) were significantly associated with PDR. Among 618 (24.2%) sequences (nodes) associated with 253 molecular transmission clusters (size range 2-13), drug resistance mutation sites included K103, E138, V179, P225, V106, V108, L210, T215, P225, K238, and A98.
The overall prevalence of PDR in China in 2022 was modest. Targeted genotypic PDR testing and medication compliance interventions must be urgently expanded to address PDR among newly diagnosed people living with HIV in China.
抗逆转录病毒药物（ARV）使用的增加导致新出现的艾滋病毒耐药性可能危及资源有限环境中标准化艾滋病毒管理方案的成功。
我们旨在描述 2022 年中国艾滋病毒阳性个体的治疗前艾滋病毒耐药性（PDR）和危险因素。
本横断面研究根据世界卫生组织的监测指南，于 2022 年在 8 个省级行政单位进行了两阶段系统抽样。从研究参与者中获取人口统计学信息和血浆样本。使用斯坦福 HIV 耐药性数据库分析 PDR，并使用 HIV-TRACE 中的 Tamura-Nei 93 模型计算遗传距离为 0.01 个替换/位点的配对匹配。使用逻辑回归确定和估计与 PDR 相关的因素。
2022 年对 2568 名参与者进行了 PDR 检测。参与者中，34.8%（n=893）年龄在 30-49 岁，81.4%（n=2091）为男性，3.2%（n=81）有既往 ARV 暴露史。蛋白酶和逆转录酶区域、非核苷类逆转录酶抑制剂、核苷类逆转录酶抑制剂和蛋白酶抑制剂的 PDR 发生率分别为 7.4%（n=190）、6.3%（n=163）、1.2%（n=32）和 0.2%（n=5）。云南、吉林和浙江的 PDR 发生率明显高于四川。与非核苷类逆转录酶抑制剂相关的耐药性，依非韦伦和奈韦拉平的发生率分别为 6.1%（n=157）和 6.3%（n=163）。多变量逻辑回归模型表明，有既往 ARV 暴露史（比值比[OR]7.45，95%置信区间 4.50-12.34）和 CRF55_01B HIV 亚型（OR 2.61，95%置信区间 1.41-4.83）与 PDR 显著相关。在与 253 个分子传播簇（大小范围 2-13）相关的 618 个（24.2%）序列（节点）中，耐药性突变位点包括 K103、E138、V179、P225、V106、V108、L210、T215、P225、K238 和 A98。
2022 年中国总体 PDR 发生率适中。必须紧急扩大针对特定人群的基因耐药性检测和药物依从性干预，以解决中国新诊断的艾滋病毒感染者中的耐药性问题。
