BACKGROUND

Transmitted drug resistance (TDR) is becoming an obstacle to the success of antiretroviral therapy (ART) as the HIV epidemic continues to spread. This study aimed to investigate the characteristics of TDR and the molecular epidemiology of ART-naive HIV-1 infections in Lishui.

METHODS

A total of 481 plasma samples were collected from ART-naive HIV-1 infections in Lishui between 2020 and 2023. The sequences acquired from infections were used to analyze the characteristics of genotype, TDR, and molecular transmission network.

RESULTS

This study discovered that the three most prevalent subtypes among the 455 sequences successfully obtained from infections in Lishui were CRF08_BC (35.8%), CRF07_BC (26.4%), and CRF01_AE (25.9%). The overall prevalence of TDR was 12.1%, and the K103N (2.4%) was the most frequent mutation. Multivariate analysis showed that CRF08_BC (OR = 5.401, P < 0.001) and CD4 cell concentration of 200-499 cells/µL (OR = 1.684, P = 0.030) were associated with a higher risk of entering the molecular transmission network and clustering, whereas the current address in other cities (OR = 0.328, P = 0.004), junior middle school (OR = 0.472, P = 0.006), and junior college or above (OR = 0.387, P = 0.045) were associated with a lower risk of clustering.

CONCLUSIONS

This study revealed that the prevalence of TDR was at an intermediate level of drug resistance, and high levels of resistance were predominantly concentrated in efavirenz (EFV) and nevirapine (NVP) among the NNRTIs. Middle-aged and older infections represented a significant proportion of the molecular transmission network. This suggests that HIV surveillance and targeted prevention and treatment interventions are essential to reduce the risk of HIV transmission.