Liu Jinjin, Fu Chaohong, Yang Xuan, Zhang Xiaohua, Wei Shuguang, Ma Jie, Zhao Qingxia, Huo Yuqi
Affiliated Infectious Diseases Hospital of Zhengzhou University (Henan Infectious Diseases Hospital, The SixthPeople's Hospital of Zhengzhou), Erqi District, No.29, Jingguang South Road, Zhengzhou, 450000, China.
Sci Rep. 2025 May 22;15(1):17825. doi: 10.1038/s41598-025-02949-1.
In China, Henan Province is a region with a high HIV burden. Furthermore, drug resistance (DR) among people living with HIV/AIDS (PLWHA) on antiretroviral therapy (ART) is becoming a critical barrier to achieving viral suppression. Monitoring DR in PLWHA with detectable viremia after ART is crucial, especially given the widespread use of NNRTI and NRTI, which have historically been the backbone of China's national ART program due to affordability and availability. In this study, plasma samples from PLWHA with viral load (VL) ≥ 40 copies/mL after ≥ 6 months of ART from January 2023 to December 2023 were collected for genotypic DR testing. Of 804 individuals with detectable viremia, a total of 14 HIV-1 subtypes were detected. The top five subtypes were B (55.97%, 450/804), CRF01_AE (22.14%, 178/804), CRF07_BC (15.42%, 124/804), CFR55_01B (3.36%, 27/804), and CRF08_BC (1.00%, 8/804). DR analysis revealed a prevalence of 67.79% (545/804). The resistance rates for non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs) were 62.94% (506/804), 53.23% (428/804), 7.34% (59/804), and 3.98% (32/804), respectively. The prevalence of DR among PLWHA below and ≥ 200 copies/mL were 40.63% (13/32) and 68.91% (532/772), respectively. Multivariate regression analysis showed that age < 29 years and 40-49 years, baseline CD4 count < 500 cells/µL, current VL of 10-10 copies/mL, and initial ART regimen of NRTIs + NNRTIs were closely associated with the occurrence of DR. These findings highlight the urgent need for expanded access to drug resistance testing and the adoption of WHO-recommended regimens, such as dolutegravir (DTG), to mitigate the growing threat of DR. Our results suggest that drug resistance testing should be applied to all PLWHA with detectable viremia, and treatment strategies should be optimized to align with global guidelines.
在中国，河南省是艾滋病毒负担较重的地区。此外，接受抗逆转录病毒疗法（ART）的艾滋病毒/艾滋病感染者（PLWHA）中的耐药性（DR）正成为实现病毒抑制的关键障碍。对接受ART后病毒血症可检测到的PLWHA进行耐药性监测至关重要，特别是考虑到非核苷类逆转录酶抑制剂（NNRTI）和核苷类逆转录酶抑制剂（NRTI）的广泛使用，由于其可承受性和可得性，它们一直是中国国家ART计划的支柱。在本研究中，收集了2023年1月至2023年12月接受ART≥6个月后病毒载量（VL）≥40拷贝/毫升的PLWHA的血浆样本进行基因分型耐药性检测。在804例病毒血症可检测到的个体中，共检测到14种HIV-1亚型。前五种亚型为B（55.97%，450/804）、CRF01_AE（22.14%，178/804）、CRF07_BC（15.42%，124/804）、CFR55_01B（3.36%，27/804）和CRF08_BC（1.00%，8/804）。耐药性分析显示患病率为67.79%（545/804）。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62.94%（506/804）、53.23%（428/804）、7.34%（59/804）和3.98%（32/804）。病毒载量低于和≥200拷贝/毫升的PLWHA中的耐药率分别为40.63%（13/32）和68.91%（532/772）。多因素回归分析表明，年龄<29岁和40 - 49岁、基线CD4细胞计数<500个/微升、当前病毒载量为10 - 10拷贝/毫升以及初始ART方案为NRTIs + NNRTIs与耐药性的发生密切相关。这些发现凸显了扩大耐药性检测的可及性以及采用世界卫生组织推荐的方案（如多替拉韦（DTG））以减轻耐药性日益增长的威胁的迫切需求。我们的结果表明，应将耐药性检测应用于所有病毒血症可检测到的PLWHA，并应优化治疗策略以符合全球指南。
