OBJECTIVE

Discontinuation of antiretroviral treatment (ART) raised drug resistance and failure of Human Immunodeficiency Virus (HIV) virological suppression. The study aimed to assess the relationship between pretreatment drug resistance (PDR) and ART dropout, as well as the relationship between HIV treatment dropout and HIV secondary transmission.

METHODS

This study included all eligible participants from a local surveillance database in southwestern China between 2014 and 2021. The PDR prevalence trend was assessed using trend Chi-square tests within a consecutive cross-sectional design (N = 3060). Cox proportional hazards model was used to investigate the relationship between PDR and the risk of treatment dropout within a cohort design. Generalized Estimating Equations model was applied to explore the association between treatment dropout and HIV secondary transmission within a longitudinal genetic network study design. (N = 5094).

RESULTS

The overall PDR prevalence was 6.2%, analyzing a study sample of 3060 individuals with HIV/AIDS. Specifically, the prevalence of PDR to non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), and protease inhibitors (PIs) was 3.6%, 1.4%, and 1.1%, respectively. Yearly difference in prevalence was not identified. The independent association between PDR to NNRTIs and treatment dropout was significant (adjusted hazard ratio: 2.55, 95% CI 1.52-4.29). Among 5094 newly diagnosed HIV cases, participants who dropped out did not show a significant difference in HIV secondary transmission compared to those not on ART (adjusted odds ratio: 1.15, 95% CI 0.74-1.79).

CONCLUSION

PDR to NNRTIs may contribute to HIV secondary transmission through treatment dropout. It is imperative to offer comprehensive and advanced HIV care for all individuals with HIV, enhance treatment and medication adherence, and closely monitor PDR prevalence.