Shu Yuanlu, Liu Jiafa, Yang Cuixian, Li Jianjian, Zhang Mi, Li Yuan, Deng Xuemei, Dong Xingqi
School of Public Health, Kunming Medical University, Kunming 650500, China.
Department of Laboratory Medicine, Yunnan Provincial Infectious Disease Hospital, Kunming 650301, China.
J Antimicrob Chemother. 2025 Apr 2;80(4):947-954. doi: 10.1093/jac/dkaf017.
This study aimed to evaluate the prevalence and characteristics of drug resistance mutations (DRMs) in patients with low-level viremia (LLV) in Southwestern China, as it has become a growing challenge in AIDS clinical practice.
This cross-sectional study was performed in Yunnan Province, Southwestern China. LLV was defined as 50-999 copies/mL of plasma viral load with antiretroviral therapy (ART) for at least 6 months. HIV-1 DRM detection used validated in-house protocol.
A total of 470 sequences were obtained, and 13 HIV-1 genotypes were identified, among which CRF08_BC (47.5%), CRF07_BC (22.3%) and CRF01_AE (10.0%) subtypes were the most prevalent. The overall prevalence of DRMs was 45.7% (215/470), and the prevalence of DRMs to non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitors (PIs) was 39.4% (185/470), 20.6% (97/470) and 5.3% (25/470), respectively. The most common NNRTI-associated mutations were K103N (16.0%), E138A (6.6%), V179D (6.6%) and P225H (4.9%), and those in NRTIs were M184V (17.0%), D67N (3.4%) and K65R (3.0%). PI-associated mutations were infrequent, occurring in less than 1.8% of cases. The prevalence of NNRTI-associated mutations (K101E and Y188C) was found to be statistically significant among various LLV groups. Additionally, significant variations were observed in the prevalence of NNRTI-associated mutations (V106I, V106M, E138A and P225H), NRTI-associated mutation (K65R) and PI-associated mutations (L33F and Q58E) across different subtypes.
The prevalence of DRMs in ART-experienced patients with LLV was high, and HIV-1 genotypes exhibited diversity in Yunnan Province. These findings indicate that regular DRM monitoring during LLV episodes was essential for effective clinical treatment and management in this region.
本研究旨在评估中国西南部低水平病毒血症（LLV）患者中耐药突变（DRM）的流行情况和特征，因为这已成为艾滋病临床实践中日益严峻的挑战。
本横断面研究在中国西南部的云南省进行。LLV定义为接受抗逆转录病毒治疗（ART）至少6个月后血浆病毒载量为50 - 999拷贝/毫升。HIV-1 DRM检测采用经过验证的内部方案。
共获得470个序列，鉴定出13种HIV-1基因型，其中CRF08_BC（47.5%）、CRF07_BC（22.3%）和CRF01_AE（10.0%）亚型最为常见。DRM的总体流行率为45.7%（215/470），对非核苷类逆转录酶抑制剂（NNRTIs）、核苷类逆转录酶抑制剂（NRTIs）和蛋白酶抑制剂（PIs）的DRM流行率分别为39.4%（185/470）、20.6%（97/470）和5.3%（25/470）。最常见的与NNRTI相关的突变是K103N（16.0%）、E138A（6.6%）、V179D（6.6%）和P225H（4.9%），与NRTIs相关的突变是M184V（17.0%）、D67N（3.4%）和K65R（3.0%）。与PI相关的突变很少见，发生率低于1.8%。在不同的LLV组中，发现与NNRTI相关的突变（K101E和Y188C）的流行率具有统计学意义。此外，在不同亚型中，与NNRTI相关的突变（V106I、V106M、E138A和P225H）、与NRTI相关的突变（K65R）和与PI相关的突变（L33F和Q58E）的流行率存在显著差异。
有ART经验的LLV患者中DRM的流行率很高，且云南省HIV-1基因型呈现多样性。这些发现表明，在该地区，对LLV发作期间进行定期DRM监测对于有效的临床治疗和管理至关重要。
