Hao Jingjing, Liu Xiu, Wang Dong, Hu Hongping, Li Fangyuan, Li Yantong, Hu Jing, Song Chang, Ruan Yuhua, Feng Yi, Wang Zheng, Shao Yiming, Liao Lingjie, Xing Hui
National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Clin Infect Dis. 2025 Apr 29. doi: 10.1093/cid/ciaf159.
Transmitted drug resistance (TDR) may compromise the effect of antiretroviral therapy (ART), highlighting the necessity for continuous monitoring.
The study was conducted across 31 provincial-level administrative divisions of China. Demographic information and blood samples were collected from participants at diagnosis of human immunodeficiency virus (HIV) infection between April and June 2023. TDR and molecular transmission networks were analyzed based on partial pol sequences via the Stanford HIV drug resistance database and HIV-TRACE, respectively. Logistic regression was utilized to identify factors associated with TDR.
HIV drug resistance genotyping was successfully performed on plasma samples from 6654 individuals. The overall TDR prevalence was 11.4% (95% confidence interval [CI], 10.6%-12.2%). Resistance to nonnucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs) was 7.9%, 0.8%, 2.4%, and 1.0%, respectively. TDR to efavirenz/nevirapine (EFV/NVP) was 6.5%. According to the surveillance drug resistance mutation list, the prevalence of TDR to total, NNRTIs, NRTIs, PIs, and INSTIs was 8.2%, 6.4%, 1.0%, 0.7%, and 0.4%. Multivariable analysis linked TDR to non-Han ethnicity (adjusted odds ratio [AOR], 1.45 [95% CI, 1.17-1.79]), unknown transmission routes (AOR, 2.56 [95% CI, 1.33-4.90]), and CD4 ≥500 cells/μL (AOR, 1.29 [95% CI, 1.05-1.58]). Higher education (high school or more) reduced TDR odds (AOR, 0.77 vs primary education).
TDR among people with newly diagnosed HIV in China exceeds 10%, with EFV/NVP TDR >5%. Timely monitoring of TDR and adjustment of ART regimens are essential to mitigate the impact of drug resistance on treatment efficacy.
传播耐药性（TDR）可能会削弱抗逆转录病毒疗法（ART）的效果，这凸显了持续监测的必要性。
该研究在中国31个省级行政区开展。于2023年4月至6月期间，在参与者被诊断为人类免疫缺陷病毒（HIV）感染时收集人口统计学信息和血样。分别通过斯坦福HIV耐药数据库和HIV-TRACE，基于部分pol序列分析TDR和分子传播网络。采用逻辑回归来确定与TDR相关的因素。
对6654名个体的血浆样本成功进行了HIV耐药基因分型。总体TDR患病率为11.4%（95%置信区间[CI]，10.6%-12.2%）。对非核苷类逆转录酶抑制剂（NNRTIs）、核苷类逆转录酶抑制剂（NRTIs）、蛋白酶抑制剂（PIs）和整合酶链转移抑制剂（INSTIs）的耐药率分别为7.9%、0.8%、2.4%和1.0%。对依非韦伦/奈韦拉平（EFV/NVP）的TDR为6.5%。根据监测耐药突变列表，对总计、NNRTIs、NRTIs、PIs和INSTIs的TDR患病率分别为8.2%、6.4%、1.0%、0.7%和0.4%。多变量分析将TDR与非汉族（调整优势比[AOR]，1.45[95%CI，1.17-1.79]）、传播途径不明（AOR，2.56[95%CI，1.33-4.90]）以及CD4≥500个细胞/μL（AOR，1.29[95%CI，1.05-1.58]）联系起来。高等教育（高中及以上）降低了TDR几率（AOR，0.77对比小学教育）。
中国新诊断HIV感染者中的TDR超过10%，EFV/NVP的TDR>5%。及时监测TDR并调整ART方案对于减轻耐药性对治疗效果的影响至关重要。
