Genetic Diversity and Characteristics of Drug Resistance Among Treatment-Naive People Living with HIV in Xi'an, China

Prevalence, Risk Factors, and Clinical Outcomes with Advanced HIV Disease Among People with Newly Diagnosed HIV During the "Treat-All" Era: A Retrospective Cohort Study From Xi'an City, China

Purpose

China launched "treat-all" in 2016 to make all HIV-positive people eligible for ART regardless of disease stage. Widespread treatment may not eliminate advanced HIV. This study investigated the prevalence, characteristics, risk factors, and clinical outcomes of advanced HIV disease (AHD) in newly diagnosed HIV-positive individuals in China during the "treat-all" period.

Patients and methods

We performed a retrospective cohort study on newly diagnosed adult ART-naive people with HIV (PWH) in Xi'an from 2016 to 2022. The prevalence of AHD and six-month mortality/loss to follow-up (LTFU) were investigated. Risk variables for AHD and predictors of mortality or LTFU in the cohort were investigated using multivariate logistic and Cox regression, respectively.

Results

Of the PWH, 47.5% (2999/6318) had AHD at HIV diagnosis. At enrollment, being ≥50 years (aOR: 1.75, 95% CI: 1.44-2.12, P < 0.001; ≥50 vs 18-29), 30-49 years (aOR: 1.43, 95% CI: 1.24-1.65, P < 0.001; 30-49 vs 18-29), opportunity infections (aOR: 7.43, 95% CI: 5.96-9.35, P < 0.001), severe anemia (aOR: 3.56, 95% CI: 1.81-7.70, P = 0.001) and liver disease (aOR: 3.09, 95% CI: 1.48-7.05, P = 0.004) were independently associated with AHD. Within 6 months of enrollment, 95.6% and 58.3% of those who died or were LTFU had AHD. AHD (aHR: 14.30, 95% CI: 4.42-46.30, P < 0.001), ≥50 years (aHR: 5.39, 95% CI: 2.10-13.82, P < 0.001; ≥50 years vs 18-29 years), those with opportunistic infections (aHR: 2.59, 95% CI: 1.54-4.34, P < 0.001), and severe anemia (aHR: 9.89, 95% CI: 5.19-18.87, P < 0.001) were independent predictors of six-month mortality.

Conclusion

Under the "treat-all" policy, Xi'an had a high prevalence of AHD upon HIV diagnosis. AHD predicted 6-month mortality. Urgent implementation of targeted strategies is necessary to minimize AHD.

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.

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.

Full-Spectrum Surveillance of Pre-Treatment HIV Drug Resistance in Southeastern China

HIV drug resistance compromises the ability of anti-retroviral therapy (ART) to suppress viral replication, resulting in treatment failure. This study investigates the prevalence of pre-treatment drug resistance (PDR) in newly diagnosed individuals in a prosperous city (Wenzhou) in Southeastern China. A cross-sectional investigation was carried out among 473 newly diagnosed ART-naive HIV-1-infected individuals between January and December 2022. The protease-reverse transcriptase (PR-RT) region and integrase (IN) region of HIV-1 were amplified by two separately nested PCRs, followed by sequencing. Drug resistance mutations (DRMs) and drug resistance to nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs) and integrase strand transfer inhibitors (INSTIs) were analyzed. The PDR prevalence was 6.5% [95% CI: 4.4-9.1] for any anti-retroviral drug, 0.9% [95% CI: 0.3-2.3] for NRTIs, 4.1% [95% CI: 2.5-6.5] for NNRTIs, 1.8% [95% CI: 0.8-3.6] for PIs and 0.5% [95% CI: 0.1-1.8] for INSTIs. According to the subtyping results of the PR-RT region, 11 different subtypes and 31 unique recombinant forms (URFs) were found. CRF07_BC was the dominant subtype (53.7%, 233/434), followed by CRF01_AE (25.3%, 110/434). V179D (1.6%) and K103N (1.4%) were the most predominant types of NNRTI DRMs. Q58E (1.2%) and M184V (0.7%) were the most frequent PI DRMs and NRTI DRMs, respectively. The INSTI-related DRMs Y143S (causes high-level resistance to RAL) and G163K (causes low-level resistance to EVG and RAL) were found in one patient each. Given the relatively high PDR prevalence of NNRTI (4.1%), non-NNRTI-based ART may be preferred in the future. It is recommended to include genotypic resistance testing before starting ART in regions where feasible.

Retrospective Study on Genetic Diversity and Drug Resistance among People Living with HIV at an AIDS Clinic in Beijing

(1) Background: The objective of this study was to investigate the prevalence of genetic diversity and drug resistance mutations among people living with HIV (PLWH) attending clinics in Beijing. (2) Methods: A retrospective analysis was conducted on PLWH admitted to the Fifth Medical Center of People's Liberation Army (PLA) General Hospital between 1 March 2013 and 31 July 2020. The participants were analyzed for pretreatment drug resistance (PDR) and acquired drug resistance (ADR). Nested polymerase chain reaction (PCR) was utilized to amplify the pol gene from plasma RNA samples obtained from the participants. Genotypic and HIV drug resistance were determined using the Stanford University HIV Drug Resistance Database. Univariate and multifactorial logistic analyses were used to assess the risk factors for PDR. (3) Results: The overall prevalence rates of PDR and ADR were 12.9% and 27.8%, respectively. Individuals treated with non-nucleoside reverse transcriptase inhibitors (NNRTIs) exhibited the highest prevalence of mutations. Specific mutation sites, such as V179D for NNRTIs and M184V and K65R for nucleoside reverse transcriptase inhibitors (NRTIs), were identified as prevalent mutations. Individuals treated with efavirenz (EFV) and nevirapine (NVP) were found to be susceptible to developing resistance. The multifactorial regression analyses indicated that the factors of circulating recombination form (CRF) genotype CRF07-BC and a high viral load were associated with an increased risk of PDR. CRF01-AE and CRF07-BC were the most prevalent HIV genotypes in our study. (4) Conclusions: The distribution of HIV genotypes in Beijing is complex. There is a need for baseline screening for HIV drug resistance among ART-naive individuals, as well as timely testing for drug resistance among ART-experienced individuals.