Characterization of HIV-1 molecular epidemiology and transmitted drug-resistance in newly diagnosed HIV-infected patients in Sichuan, China

Analysis of Manifestations and Associated Factors of HIV-1 Associated Thrombocytopenia in a General Teaching Hospital in Western China

Background

Thrombocytopenia frequently occurs with HIV-1 infection and plays a vital role in the deterioration of the Blood-Brain Barrier (BBB) and the development of neuroinflammation. This study aims to assess the prevalence and risk factors for HIV-1 associated thrombocytopenia (HAT) and summarize the characteristics of HAT-related neuroinflammation.

Methods

A retrospective study of HAT patients was conducted in a general teaching hospital from January 2017 to December 2021. Clinical and laboratory data from HIS and LIS were analyzed to determine the prevalence and risk factors for HAT and manifestations of HAT with neuroinflammation.

Results

The prevalence of HAT was 11.06%, with a majority of male patients (76.92%), individuals aged 50 and older (55.21%), and 63.80% experiencing mild thrombocytopenia. Significant differences were observed in CD4+ T cell count, platelet crit (PCT), and the proportion of large platelets (P-LCR) between the HAT and control groups (P<0.001, P<0.001, P=0.002). A CD4+ T cell count <200 cells/μL (P=0.001) was identified as a significant risk factor for HAT, while advanced age and high viral load were closely associated with HAT occurrence. HAT Patients with neuroinflammation were predominantly male (X2=10.066, P=0.007), had higher viral loads (X2=12.297, P=0.006), advanced age (X2=11.721, P=0.02), neuropsychiatric symptoms, and elevated levels of inflammatory factors such as IL-6 and proteins in cerebrospinal fluid (CSF).

Conclusion

In HIV-1 infection, the activation of monocytes, macrophages, and microglia leads to thrombocytopenia and neuroinflammation, highlighting the importance of recognizing HAT and HAT with neuroinflammation. Advanced age, lower CD4+ T cell count, and high viral load are closely linked to their occurrence.

Characterization of the HIV-1 molecular network in a middle-aged population aged 50 years and older in a City in Southern Sichuan, China

This study aimed to investigate the characteristics of the HIV-1 molecular network among newly diagnosed HIV-infected patients in southern Sichuan City. Plasma samples will be collected from eligible study subjects (n = 1249) during a cross-sectional survey conducted between 2016 and 2020. The HIV-1 polymerase (pol) gene sequences obtained from the collected samples will be used to perform phylogenetic analysis and characterize the genetic subtypes' molecular transmission networks. HIV-1 pol region sequences were successfully amplified in 898 cases, and seven genotypes were obtained, with CRF01_AE (331, 36.86%) and CRF07_BC (368, 40.98%) subtypes as the predominant prevalent strains in the region. 601 sequences entered the molecular transmission network. There were 302 highly connected individuals. Further multivariate analysis showed that the older the age (60-69 years, OR = 1.595, 95% CI: 1.026-2.479; ≥70 years, OR = 2.189, 95% CI: 1.295-3.699), RX and GJ counties (OR = 4.654, 95% CI: 2.776-7.803; OR = 6.847, 95% CI: 3.464-13.533) and CRF08_BC subtype (OR = 2.031, 95% CI: 1.225-3.367) were both more likely to be highly connected individuals. To effectively combat this local HIV-1 epidemic, HIV prevention and intervention programs should target older adults at least 60 years of age and registered residents in districts and counties within RX and GJ.

The changing molecular epidemiology of HIV-1 in Liangshan prefecture, China, in 2021-2023

Introduction

Liangshan Prefecture is one of the areas in China most severely affected by human immunodeficiency virus (HIV), but little is known about the molecular epidemiology of HIV-1 in this area. We aimed to analyze the distribution of HIV-1 genetic variants in Liangshan Prefecture in recent years.

Methods

8,523 blood samples were collected from people living with HIV with treatment failure and newly diagnosed individuals in all 17 counties and cities in Liangshan Prefecture between 2021 and 2023.

Results

The majority of study participants were male (66%), farmers (78%) and illiterate (53%). The main HIV-1 transmission routes were heterosexual contact (57%) and injecting drug use (27%). Among the 6,298 successfully obtained pol sequences the following HIV-1 variants were identified: CRF07_BC (93.9%), CRF08_BC (3.3%), CRF01_AE (1.4%), URFs (0.9%), CRF105_0108 (0.1%), CRF55_01B (0.1%), subtype B (0.1%), subtype C (0.1%), CRF88_BC (0.1%), CRF83_cpx (0.1%), CRF85_BC (0.03%), CRF67_01B (0.02%), CRF77_cpx (0.02%), and subtype A (0.02%). During the study period, the proportion of CRF07_BC gradually decreased, while other HIV-1 variants increased, a shift seen across all counties in Liangshan Prefecture. Newly diagnosed patients mainly acquired HIV through heterosexual transmission (86.7%), had a lower proportion of CRF07_BC (90.9%) and higher proportion of other HIV-1 variants, compared to treatment failure patients.

Conclusion

Future prevention and control policies need to take these changes into account.

Prevalence and transmission of HIV-1 drug resistance mutations among patients with treatment failure and newly diagnosed people in Liangshan Prefecture, China, in 2021-2023

Introduction

Despite expanded antiretroviral therapy (ART) in China, HIV transmission persists. Liangshan Prefecture is one of the areas in China most severely affected by HIV, with high levels of drug resistance. A deeper understanding of HIV-1 drug resistance can lead to improvements in current treatment policies.

Methods

We conducted an analysis of HIV drug resistance mutations (DRMs) among patients with treatment failure and people newly diagnosed with HIV in Liangshan Prefecture. 8,523 blood samples were collected from people living with HIV with treatment failure and newly diagnosed individuals in all 15 counties and two cities in Liangshan Prefecture between 2021 and 2023.

Results

43.0% of patients with treatment failure acquired HIV through the heterosexual route, followed by injecting drug use (38.7%), while newly diagnosed individuals mainly acquired HIV through the heterosexual route (86.7%). 95.6% of patients with treatment failure were infected with HIV-1 variant CRF07_BC and 2.7% with CRF08_BC, and newly diagnosed individuals were also main infected with HIV-1 variant CRF07_BC (90.9), followed by CRF08_BC (4.0%) and CRF01_AE (2.5%). The overall prevalence of acquired drug resistance (ADR) among patients with treatment failure was 57.4%. The overall prevalence of pre-treatment drug resistance (PDR) among newly diagnosed individuals was 23.9%. A high prevalence of ADR and PDR (especially high-level resistance) to efavirenz (48.0% vs. 11.1%) and nevirapine (49.6% vs. 11.4%) was found. The main non-nucleoside reverse transcriptase inhibitor (NNRTI)-associated ADR and PDR mutations were K103, V106, and V179. Our findings highlight age <18 years, injecting drug use, and initiation on NNRTI-based regimen as independent risk factors for HIV ADR development. We found minor variants as a risk factor for PDR, and CRF01_AE was associated with a higher risk than CRF07_BC for nucleoside reverse transcriptase inhibitor (NRTI) PDR.

Discussion

Given the high levels of NNRTI ADR and PDR, future clinical treatment plans should minimize the use of NNRTI-based regimens and should instead adopt alternative ART regimens more frequently.

Molecular network analysis for detecting HIV transmission clusters: insights and implications

Objective

In order to improve knowledge of HIV transmission dynamics and guide preventive and control strategies, this work uses molecular cluster analysis to objectively detect clusters of HIV genetic sequence similarity.

Methods

89 HIV-positive couples provided blood samples, and plasma was separated for pol region gene sequence amplification. Furthermore, analyzed HIV-1 pol fragment sequences from Nanjing patients between 2015 and 2019. HYPHY and Cytoscape were used to generate and illustrate molecular networks.

Results

In this investigation of 89 double-positive pairs, it was discovered that the pairwise gene distance approach properly detected 82.02% of positive couples at an ideal gene distance of 0.014 substitution/loci. With an accuracy of 86.25%, the optimal parameter for the phylogenetic tree and gene distance approach was 90 + 0.045 substitution/loci. A molecular network was built for the Nanjing samples (2015-2019) using the optimum threshold of the previous technique. This network had 487 sequences with one misconnected cluster. There were 565 sequences in the network created by the latter approach that were not incorrectly connected.

Conclusion

For HIV research, molecular cluster analysis provides novel insights. It helps with preventive and control methods by objectively identifying clusters with comparable genetic sequences, which enhances our knowledge of HIV transmission. Further developments will increase its importance for HIV/AIDS research and worldwide prevention.

Pretreatment HIV Drug Resistance to Integrase Strand Transfer Inhibitors Among Newly Diagnosed HIV Individuals - China, 2018-2023

Introduction

The widespread adoption of integrase strand transfer inhibitors (INSTIs) has led to the emergence of INSTI-associated drug-resistance mutations. This cross-sectional study conducted a comprehensive national survey to investigate the prevalence of pretreatment drug resistance (PDR) to INSTIs among newly diagnosed human immunodeficiency virus (HIV) individuals in China.

Methods

The study enrolled 10,654 individuals from 31 provincial-level administrative divisions between 2018 and 2023. All participants underwent integrase region genotypic resistance testing. PDR to INSTIs was analyzed using the Stanford HIV drug resistance database, and molecular transmission networks were constructed using HIV-TRACE.

Results

The overall PDR prevalence of INSTIs was 0.95%. The predominant major and accessory mutations identified were E138K/A (n=19) and G163R/K (n=29), respectively. Multivariable logistic regression analysis revealed that age ≥50 years [adjusted odds ratio (aOR)=1.87, 95% confidence interval (CI): 1.03, 3.42] and HIV subtype B (aOR=3.87, 95% CI: 1.97, 7.58) were significant risk factors for PDR. Molecular network analysis showed that 1,257 (26.0%) CRF07_BC sequences formed 432 transmission clusters, while 811 (27.6%) CRF01_AE sequences were associated with 335 clusters. The identified drug-resistance mutations included E138K/A, R263K, Y143H, G163R/K, E157Q, and T97A.

Conclusions

The current prevalence of PDR to INSTIs in China remains low. However, given the increasingly widespread use of INSTIs, continuous surveillance of drug resistance emergence and transmission patterns is essential.

Exploring disparities in HIV-1 pretreatment and acquired drug resistance in China from 2003 to 2022

OBJECTIVES

To investigate the epidemic patterns of pretreatment drug resistance (PDR) and acquired drug resistance (ADR) in HIV-1 sequences from China.

METHODS

HIV-1 pol sequences and associated epidemiological data were collected from the Los Alamos HIV Sequence Database, NCBI, HIV Gene Sequence Database and PubMed. Genotypic resistance and subtypes were identified using the Stanford HIV Drug Resistance Database.

RESULTS

A total of 36 263 sequences from ART-naïve individuals and 1548 sequences from ART-experienced individuals with virological failure were evaluated. PDR prevalence was 6.64%, initially decreasing and then increasing to 7.84% (2018-22) due to NNRTI. Pooled ADR prevalence (44.96%) increased, with NNRTI and NRTI aligning with the overall trend. The percentage of multidrug resistance was more than that of single-drug resistance in PDR and especially ADR annually. PDR was most prevalent in Central China followed by Southwest and North. ADR prevalence was highest in North China followed by Northwest and Southwest. In ADR sequences, high-level resistance was more common, especially in NRTI. PDR sequences exhibited low-level or intermediate resistance, especially PI. Drug resistance mutations revealed distinct patterns in PDR and ADR. CRF01_AE, the predominant subtype in China, exhibited the highest proportions among most ART drugs and drug resistance mutations, with a few exceptions where CRF07_BC (prominent in the Northwest), CRF55_01B and CRF08_BC (prominent in the Southwest) showed the highest proportions.

CONCLUSIONS

HIV-1 PDR and ADR prevalence in China exhibited diverse epidemiological characteristics, underscoring the importance of ongoing national monitoring of PDR, ADR and subtype; patient education on adherence; and personalized regimens.

[Analysis of HIV-1 Subtypes and Transmitted Drug Resistance in Hospitalized Treatment-Native Patients With AIDS]

Objective

To investigate the distribution characteristics of HIV-1 subtypes, the status of transmitted drug resistance (TDR), and the influencing factors of TDR in treatment-naive patients with AIDS who are hospitalized.

Methods

Treatment-naive patients with AIDS who were admitted to the Infectious Disease Department, Public Health Clinical Center of Chengdu between January 2020 and December 2022 were enrolled in the study. The diagnosis and confirmation diagnosis of all the subjects were made at the same hospital. Blood samples were collected from the subjects before antiretroviral therapy (ART). The in-house method was used for HIV gene amplification and sequencing. A phylogenetic tree was constructed to analyze the HIV-1 subtypes. The Stanford HIV Drug Resistance Database was used to conduct an online comparative analysis of the drug resistance mutation sites and to determine the types and levels of drug resistance. The distribution characteristics of HIV-1 subtypes, the occurrence of TDR, and the influencing factors of TDR were analyzed.

Results

A total of 213 patients were included in the study and their blood samples were collected. HIV-1 subtypes were successfully amplified in 83.10% (177/213) of the subjects. Ten HIV subtypes were identified, with CRF07_BC being the most common subtypes, accounting for 43.50% (77/177), which was followed by CRF01_AE at 37.85%. Unique recombinant forms (URFs) were relatively uncommon, accounting for 8.47%. The other subtypes accounted for 10.17%. These 4 categories of HIV-1 subtypes were distributed with statistically significant differences in different age groups (P=0.024). Further analysis revealed significant differences in the distribution of the HIV-1 subtypes of CRF01_AE and URFs between the groups of patients aged 30-50 years and those over 50. In addition, URFs accounted for a higher proportion in patients aged 30 to 50 years (P=0.008). The incidences of TDR were 6.49%, 8.96%, 13.33%, and 5.56% for CRF07_BC, CRF01_AE, URFs, and other subtypes, respectively, showing no significant difference (P>0.05). The overall TDR was 6.57%. The TDR for non-nucleoside reverse transcriptase inhibitors (NNRTIs) was 5.16%, and the main mutation sites were V179D/E, E138A/G, V106M/I, and Y181C. The TDR for nucleoside reverse transcriptase inhibitors (NRTIs) was 1.88%, and the main mutation site was M184V. One patient was found to be resistant to both NNRTIs and NRTIs. The highly resistant rate was 4.23%, moderate resistance was 0.47%, and low resistance was 1.88%. No significant effects of the specific years, demographic characteristics, transmission route, baseline condition, and opportunistic infections on TDR were found in this study (P>0.05).

Conclusions

The HIV-1 subtypes are diverse and complex in treatment-naive patients with AIDS who were hospitalized. The overall prevalence of TDR is relatively high. It is necessary to strengthen HIV drug resistance testing to optimize ART treatment and reduce the risk of drug resistance transmission.

Characteristics of Subtype and Molecular Transmission Networks among Newly Diagnosed HIV-1 Infections in Patients Residing in Taiyuan City, Shanxi Province, China, from 2021 to 2023

The HIV-1 pandemic, spanning four decades, presents a significant challenge to global public health. This study aimed to understand the molecular transmission characteristics of newly reported HIV infections in Taiyuan, Shanxi Province, China, to analyze the characteristics of subtypes and the risk factors of the transmission network, providing a scientific basis for precise prevention and intervention measures. A total of 720 samples were collected from newly diagnosed HIV-1 patients residing in Taiyuan between 2021 and 2023. Sequencing of partial genes of the HIV-1 pol gene resulted in multiple sequence acquisitions and was conducted to analyze their subtypes and molecular transmission networks. Out of the samples, 584 pol sequences were obtained, revealing 17 HIV-1 subtypes, with CRF07_BC (48.29%), CRF01_AE (31.34%), and CRF79_0107 (7.19%) being the dominant subtypes. Using a genetic distance threshold of 1.5%, 49 molecular transmission clusters were generated from the 313 pol gene sequences. Univariate analysis showed significant differences in the HIV transmission molecular network in terms of HIV subtype and household registration (p < 0.05). Multivariate logistic regression analysis showed that CRF79_0107 subtype and its migrants were associated with higher proportions of sequences in the HIV transmission network. These findings provide a scientific foundation for the development of localized HIV-specific intervention strategies.

Molecular network characteristics and drug resistance analysis of 392 newly reported MSM HIV/AIDS cases in Chongqing, China

To comprehensively investigate the molecular transmission patterns of HIV-1 genotypes among men who have sex with men (MSM) in Chongqing, we employed 392 pol sequences of MSM to construct a phylogenetic tree and gene transmission network. Among the viral subtypes, CRF07_BC accounted for 73.2% (287/392) and CRF01_AE accounted for 20.7% (81/392), emerging as the predominant subtypes in this investigation. Additionally, we observed the presence of CRF55_01B, subtype B, CRF08_BC and other circulating recombinant forms. The HIV-1 molecular network was constructed with a gene distance threshold of 1.5%, resulting in an entry rate of 61.4% (241/392). Within the network, we identified a total of 23 molecular clusters, with the largest cluster being the CRF07_BC molecular cluster comprising 148 node values. Transmitted drug-resistance (TDR) mutations were found in 4.34% of the cases, with 1.79% associated with protease inhibitors (PIs), 0.51% with nucleoside reverse transcriptase inhibitors (NRTIs), and 2.55% with non-nucleoside reverse transcriptase inhibitors (NNRTIs). Statistical analysis indicated a higher enrollment rate in the HIV-1 molecular network among infected individuals with the CRF07_BC subtype, those identifying with same-sex sexual roles as "vers," and individuals with higher education levels. This suggests the need for strengthened investigation and intervention in this population to prevent the formation of larger transmission clusters. Furthermore, continuous monitoring of the HIV-1 molecular dynamics network is necessary to promptly and accurately track changes in molecular epidemic characteristics.

The profile of HIV-1 drug resistance in Shanghai, China: a retrospective study from 2017 to 2021

BACKGROUND

HIV-1 drug resistance is a huge challenge in the era of ART.

OBJECTIVES

To investigate the prevalence and characteristics of acquired HIV-1 drug resistance (ADR) in Shanghai, China.

METHODS

An epidemiological study was performed among people living with human immunodeficiency virus (PLWH) receiving ART in Shanghai from January 2017 to December 2021. A total of 8669 PLWH were tested for drug resistance by genotypic resistance testing. Drug resistance mutations (DRMs) were identified using the Stanford University HIV Drug Resistance Database program.

RESULTS

Ten HIV-1 subtypes/circulating recombinant forms (CRFs) were identified, mainly including CRF01_AE (46.8%), CRF07_BC (35.7%), B (6.4%), CRF55_01B (2.8%) and CRF08_BC (2.4%). The prevalence of ADR was 48% (389/811). Three NRTI-associated mutations (M184V/I/L, S68G/N/R and K65R/N) and four NNRTI-associated mutations (V179D/E/T/L, K103N/R/S/T, V106M/I/A and G190A/S/T/C/D/E/Q) were the most common DRMs. These DRMs caused high-level resistance to lamivudine, emtricitabine, efavirenz and nevirapine. The DRM profiles appeared to be significantly different among different subtypes.

CONCLUSIONS

We revealed HIV-1 subtype characteristics and the DRM profile in Shanghai, which provide crucial guidance for clinical treatment and management of PLWH.

HIV-1 drug resistance and genetic transmission network among newly diagnosed people living with HIV/AIDS in Ningbo, China between 2018 and 2021

BACKGROUND

As the HIV epidemic continues to grow, transmitted drug resistance(TDR) and determining relationship of HIV transmission are major barriers to reduce the risk of HIV transmissions.This study aimed to examine the molecular epidemiology and TDR and evaluated the transmission pattern among newly diagnosed people living with HIV/AIDS(PLWHA) in Ningbo city, which could contribute to the development of targeted precision interventions.

METHODS

Consecutive cross-sectional surveys were conducted in Ningbo City between January 2018 and December 2021. The HIV-1 pol gene region was amplified and sequenced for drug resistance and genetic transmission network analysis. TDR was determined using the Stanford University HIV Drug Resistance Database. Genetic transmission network was visualized using Cytoscape with the genetic distance threshold of 0.013.

RESULTS

A total of 1006 sequences were sequenced successfully, of which 61 (6.1%) showed evidence of TDR. The most common mutations were K103N (2.3%), E138A/G/Q (1.7%) and V179D/E (1.2%). 12 HIV-1 genotypes were identified, with CRF07_BC being the major genotype (43.3%, 332/767), followed by CRF01_AE (33.7%, 339/1006). 444 (44.1%) pol sequences formed 856 links within 120 transmission clusters in the network. An increasing trend in clustering rate between 2018 and 2021(χ2 = 9.546, P = 0.023) was observed. The odds of older age (≥ 60 years:OR = 2.038, 95%CI = 1.072 ~ 3.872, compared to < 25 years), HIV-1 genotypes (CRF07_BC: OR = 2.147, 95%CI = 1.582 ~ 2.914; CRF55_01B:OR = 2.217, 95%CI = 1.201 ~ 4.091, compared to CRF01_AE) were significantly related to clustering. Compared with CRF01_AE, CRF07_BC were prone to form larger clusters. The largest cluster with CRF07_BC was increased from 15 cases in 2018 to 83 cases in 2021.

CONCLUSIONS

This study revealed distribution of HIV-1 genotypes, and genetic transmission network were diverse and complex in Ningbo city. The prevalence of TDR was moderate, and NVP and EFV were high-level NNRTI resistance. Individuals aged ≥ 60 years old were more easily detected in the networks and CRF07_BC were prone to form rapid growth and larger clusters. These date suggested that surveillance and comprehensive intervention should be designed for key rapid growth clusters to reduce the potential risk factors of HIV-1 transmission.

Prevention and Control Are Not a Regional Matter: A Spatial Correlation and Molecular Linkage Analysis Based on Newly Reported HIV/AIDS Patients in 2021 in Jiangsu, China

HIV-related spatial analysis studies in China are relatively few, and Jiangsu Province has not reported the relevant data in recent years. To describe the spatial distribution and molecular linkage characteristics of HIV-infected patients, this article combined descriptive epidemiology, spatial analysis, and molecular epidemiology methods to analyze patient reporting, patient mobility information, and HIV sequence information simultaneously. The results showed that HIV reporting profiles differed among Jiangsu cities, with the reporting rate in southern Jiangsu being above average. There was a spatial autocorrelation (Global Moran I = 0.5426, p < 0.05), with Chang Zhou showing a High-High aggregation pattern. Chang Zhou and Wu Xi were identified as hotspots for HIV reporting and access to molecular transmission networks. Some infected individuals still showed cross-city or even cross-province mobility after diagnosis, and three were linked with individuals in the destination cities within the largest molecular transmission cluster, involving 196 patients. The cross-city or cross-province mobility of patients may result in a potential HIV transmission risk, suggesting that combining timely social network surveys, building an extensive transmission network across cities and provinces, and taking critical regions and key populations as entry points could contribute to improved prevention and control efficiency and promote achievement of the 95-95-95 target and cascade.

The Update of HIV-1 Prevalence and Incidence and Spatio-Temporal Analyses of HIV Recent Infection Among Four Sub-Groups in Sichuan, China During Surveillance Period Between 2016 and 2022

Background

Sichuan Province has gradually become a hot-spot for HIV/AIDS. Little is known about the HIV-1 incidence and prevalence among four sub-groups since 2015. Meanwhile, the distributions of hot-spot areas related to recent infection cases that indicate current transmission among the four subgroups are also rare.

Objective

The main purpose of this study was to assess the HIV-1 prevalence and incidence and to visualize the distributions of hot-spot areas of current transmission among four subgroups (people who inject drugs, male STD clinic attendees, female sex workers and men who had sex with men) during the surveillance period in Sichuan province between 2016 and 2022.

Results

Of the 267,617 individuals, 2158 HIV-positive samples were tested with Lag-Avidity EIA, among which 493 samples were identified as recent infections. Among people who inject drugs (PWID), both HIV-1 prevalence (from 1.41% to 0.34%) and incidence (from 0.03% to 0.140%) showed a significant decreasing trend. Among men who had sex with men (MSM), female sex workers (FSWs), and male STD clinic attendees, HIV-1 prevalence indicated significant decreasing trends, whereas HIV-1 incidence showed no significant changes. Spatial analysis demonstrated the formation of hot-spots and clusters of current transmissions sharing regional differences, mainly concentrated in the southeast, and most of these were consecutive hot-spots.

Conclusion

The prevention and control were efficacious and persistent. However, among the other three subgroups, there is a need for a regional cooperative in prevention and control approaches and collaborative research in many aspects.

Using molecular network analysis to understand current HIV-1 transmission characteristics in an inland area of Yunnan, China

HIV-1 molecular surveillance provides a new approach to explore transmission risks and targeted interventions. From January to June 2021, 663 newly reported HIV-1 cases were recruited in Zhaotong City, Yunnan Province, China. The distribution characteristics of HIV-1 subtypes and HIV-1 molecular network were analysed. Of 542 successfully subtyped samples, 12 HIV-1 strains were identified. The main strains were CRF08_BC (47.0%, 255/542), CRF01_AE (17.0%, 92/542), CRF07_BC (17.0%, 92/542), URFs (8.7%, 47/542), and CRF85_BC (6.5%, 35/542). CRF08_BC was commonly detected among Zhaotong natives, illiterates, and non-farmers and was mostly detected in Zhaoyang County. CRF01_AE was frequently detected among married and homosexual individuals and mostly detected in Weixin and Zhenxiong counties. Among the 516 pol sequences, 187 (36.2%) were clustered. Zhaotong natives, individuals aged ≥60 years, and illiterate individuals were more likely to be found in the network. Assortativity analysis showed that individuals were more likely to be genetically associated when stratified by age, education level, occupation, and reporting area. The genetic diversity of HIV-1 reflects the complexity of local HIV epidemics. Molecular network analyses revealed the subpopulations to focus on and the characteristics of the risk networks. The results will help optimise local prevention and control strategies.

HIV-1 molecular transmission network and drug resistance in Chongqing, China, among men who have sex with men (2018-2021)

BACKGROUND

Over the past few years, HIV transmission among men who have sex with men (MSM) in China has increased significantly. Chongqing, located in the southwest of China, has the highest prevalence of HIV among MSM in the country.

METHODS

Blood samples were taken from 894 MSM in Chongqing who had recently been diagnosed with HIV-1 infection and had not yet started getting treatment. In order to determine the distribution of HIV-1 subtypes, transmitted drug resistance, and assessments of molecularly transmitted clusters, we sequenced the Pol genes and employed them in phylogenetic analysis. The genetic distance between molecular clusters was 1.5%. To find potential contributing factors, logistic regression analyses were performed.

RESULTS

Of the 894 HIV-1 pol sequences acquired from study participants, we discovered that CRF07_BC (73.6%) and CRF01_AE (19.6%) were the two most prevalent HIV-1 genotypes in Chongqing among MSM, accounting for 93.2% of all infections. In addition, CRF08_BC (1.1%), B subtype (1.0%), CRF55_01B (3.4%), and URF/Other subtypes (1.3%) were less frequently observed. Among MSM in Chongqing, transmitted drug resistance (TDR) was reported to be present at a rate of 5.6%. 48 clusters with 600 (67.1%, 600/894) sequences were found by analysis of the molecular transmission network. The distributions of people by age, sexual orientation, syphilis, and genotype were significantly differentially related to being in clusters, according to the multivariable logistic regression model.

CONCLUSION

Despite the low overall prevalence of TDR, the significance of genotypic drug resistance monitoring needs to be emphasized. CRF07_BC and CRF01_AE were the two main genotypes that created intricate molecular transmission networks. In order to prevent the expansion of molecular networks and stop the virus's spread among MSM in Chongqing, more effective HIV intervention plans should be introduced.

Treatment persistence of bictegravir/emtricitabine/tenofovir alafenamide and efavirenz + lamivudine + tenofovir disoproxil among HIV-1 patients newly starting treatment in Hunan Province in China

BACKGROUND

Though bictegravir/emtricitabine/tenofovir (BIC/FTC/TAF) have been regulatory approved and included in the National Reimbursement Drug List in China, due to the affordability concern, generic version of efavirenz + lamivudine + tenofovir (EFV + 3TC + TDF) is still recommended as the first-line therapy in the clinical guideline and widely used in clinical practice. The aim of the study is to assess the persistence with first-line BIC/TAF/TAF and EFV + 3TC + TDF in newly treated HIV-1 patients in the real-world setting in Hunan Province in China.

METHODS

A retrospective analysis of the medical records of HIV patients initiating first-line antiretroviral therapy in the First Hospital of Changsha in January 1st, 2021-July 31st, 2022 was conducted. Persistence was assessed as the number of days on the therapy from the index until treatment discontinuation or end of data availability. Kaplan-Meier Curves and Cox Proportional Hazard models were used to evaluate the discontinuation rates. Subgroup analysis was performed excluding BIC/FTC/TAF patients with treatment discontinuation due to economic reason, and EFV + 3TC + TDF patients with a viral load > 500,000 copies/mL.

RESULTS

A total of 310 eligible patients were included in the study, with 244 and 66 patients in the BIC/FTC/TAF group and EFV + 3TC + TDF group, respectively. Compared with EFV + 3TC + TDF patients, BIC/FTC/TAF patients were older, more living in the capital city currently, and had significantly higher total cholesterol and low-density level (all p < 0.05). No significant difference was shown in the time to discontinuation between BIC/FTC/TAF patients and EFV + 3TC + TDF patients. After excluding BIC/FTC/TAF patients with treatment discontinuation due to economic reason, EFV + 3TC + TDF group were shown to have a significantly higher risk of discontinuation than BIC/FTC/TAF group (hazard ratio [HR] = 11.1, 95% confidence interval [CI] = 1.3-93.2). After further removing the EFV + 3TC + TDF patients with a viral load > 500,000 copies/mL, the analysis showed similar results (HR = 10.1, 95% CI = 1.2-84.1). 79.4% of the EFV + 3TC + TDF patients discontinued treatment due to clinical reasons, while 83.3% of the BIC/FTC/TAF patients discontinued treatment due to economic reasons.

CONCLUSIONS

Compared with BIC/FTC/TAF, EFV + TDF + 3TC patients were significantly more likely to discontinue the first-line treatment in Hunan Province in China.