Pretreatment drug resistance in people living with HIV: A large retrospective cohort study in Chongqing, China

Liu, Min; He, Xiaoqing; Deng, Renni; Tang, Sheng‐Quan; Harypursat, Vijay; Lu, Yanqiu; He, Kun; Huo, Qin; Yang, Hong‐Hong; Liu, Qian; Chen, Yaokai

doi:10.1111/hiv.13253

Cited by 13 publications

(9 citation statements)

References 26 publications

(58 reference statements)

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“…Among the 295 participants, 42.4% were found to carry DRMs, which was higher than the similar studies [ 14 ]. The proportion of participants carried NNRTI resistance-associated mutations was far higher compared with the proportion of participants carried NRTI and PI resistance-associated mutation, which was consistent with the similar studies [ 17 ].…”

Section: Discussionmentioning

confidence: 62%

HIV-1 pretreatment drug resistance and genetic transmission network in the southwest border region of China

Chen

Li³

et al. 2022

BMC Infect Dis

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Background HIV drug resistance increased with the widespread use of antiretroviral drugs, and posed great threat to antiretroviral therapy (ART). Pu’er Prefecture, lying in the southwest of Yunnan Province, China, borders Myanmar, Laos and Vietnam, is also the area where AIDS was discovered earlier, however, in which there has been no information on HIV drug resistance. Methods A cross-sectional survey of pretreatment drug resistance (PDR) was conducted in Pu’er Prefecture in 2021. Partial pol gene sequences were obtained to analyze drug resistance and construct genetic transmission network. HIV drug resistance was analyzed using the Stanford University HIVdb algorithm. Results A total of 295 sequences were obtained, among which 11 HIV-1 strain types were detected and CRF08_BC (62.0%, 183/295) was the predominant one. Drug resistance mutations (DRMs) were detected in 42.4% (125/295) of the sequences. The prevalence of PDR to any antiretroviral drugs, nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were 10.8% (32/295), 9.5% (28/295), 1.0% (3/295) and 0.3% (1/295), respectively. The risk of PDR occurrence was higher among individuals with CRF01_AE strain types. HIV-1 molecular network was constructed, in which 56.0% (42/75) of links were transregional, and 54.7% (41/75) of links were associated with Lancang County. Among the sequences in the network, 36.8% (35/95) harbored DRMs, and 9.5% (9/95) were drug resistance strains. Furthermore, 8 clusters had shared DRM. Conclusion The overall prevalence of PDR in this study was in a moderate level, but NNRTIs resistance was very approaching to the threshold of public response initiation. PDR was identified in the transmission network, and DRMs transmission was observed. These findings suggested that the consecutive PDR surveillance should be conducted in this region.

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Section: Discussionmentioning

confidence: 62%

HIV-1 pretreatment drug resistance and genetic transmission network in the southwest border region of China

Chen

Li³

et al. 2022

BMC Infect Dis

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“…We detected few PI-related mutations, and the main mutation site identified was M46L/I, in agreement with survey results from Shanghai and Chongqing. 9 , 33 As PIs have a relatively high drug resistance barrier and are often used as second-line treatments in China, 34 the current drug resistance level is significantly lower for PIs than for NNRTIs or NRTIs. This suggests that non-NNRTI drugs, such as PI-based antiviral drugs, could be the preferred regimen when resistance to NNRTIs is experienced.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of HIV Transmitted Drug Resistance in Nanjing from 2018 to 2021

Su¹,

Qi²,

Zhong³

et al. 2023

IDR

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Background Transmitted drug resistance (TDR) is a major challenge in the clinical management of acquired immunodeficiency syndrome (AIDS). Therefore, this study aimed to investigate the epidemic characteristics of and risk factors for human immunodeficiency virus (HIV)-1 TDR in Nanjing from 2018 to 2021 to provide support for clinical management. Methods The HIV-1 Pol gene was amplified by nested reverse transcription polymerase chain reaction from venous blood of 1190 HIV-infected patients who did not receive antiviral therapy, and the amplified product was sequenced using an in-house sequencing method. The sequencing result was compared with the HIV drug resistance database from Stanford University to elucidate the rates of antiviral drug resistance and distribution of drug-resistant mutation sites. Factors associated with TDR were evaluated using a logistic regression model. Results Detection of drug resistance at the gene level was successful in 1138 of 1190 HIV-1-infected patients (95.6%), and the overall 4-year drug resistance rate was 8.2% (93/1138). The drug resistance rate was higher for non-nucleoside reverse transcriptase inhibitors (NNRTIs; 6.7%) than for nucleoside reverse transcriptase inhibitors (NRTIs; 2.5%) or protease inhibitors (PIs; 0.1%) ( χ 2 = 83.907, P<0.0001). The most common NNRTI-related mutation was V179D/E followed by K103N. M184V was the dominant NRTI-associated mutation, and M46L/I was the most prevalent PI-associated mutation. A CD4 + T cell count of <50 cells/μL was significantly associated with an increased risk of TDR (OR=3.62, 95% CI: 1.38–9.51, P=0.009). Conclusion The prevalence of TDR in the city of Nanjing from 2018 to 2021 was at a moderate epidemic risk according to World Health Organization standards. Continuous monitoring of TDR can inform clinical diagnosis and treatment. Patients with advanced disease and a low CD4 + T lymphocyte count are more likely to have TDR in Nanjing.

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“…Among the patient genotypes included in the study, CRF01_AE and CRF07_BC were the dominant, consistent with previous studies. [5,14] However, in the PDR arm, these 2 major genotypes accounted for only 49% of the cases. A majority of the genotypes were other uncommon types, especially CRF55_01B (15.4%, 16/104), sub-type B (13.5%, 14/104), and URFs (12.5%, 13/104).…”

Section: Discussionmentioning

confidence: 99%

“…Recommendations to detect HIV PDR before the initiation of ART have been issued by the WHO since 2008 [11] and European guidelines in 2017. [12] Pretreatment drug resistance mutations were found in 3.6% of the 5627 HIV cases in China in 2015, [13] 10.8% of the cases in Chongqing in 2022, [14] 11.5% of the cases in Tianjin in 2020, [15] and 4.9% among cases of men who have sex with men (MSM) in 19 cities in 2010. [16] In our study, the prevalence of PDR was 6.46%, which was above the moderate drug resistance warning line and those reported in previous studies.…”

Section: Discussionmentioning

confidence: 99%

Pre-treatment Drug Resistance Could Impact the 96-Week Antiretroviral Efficacy in Treatment-Naive HIV-1–Infected Patients in Guangdong, China

Guo¹,

Lan²,

Li³

et al. 2022

Infect Dis Immun

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BackgroundWith the high prevalence of pre-treatment drug resistance (PDR) and the potential impact to the virological inhibition, the detection of PDR was particularly necessary. This study aimed to determine the prevalence of PDR in Guangdong, China, and its impact on antiretroviral therapy (ART) in treatment-naive HIV patients.MethodsA retrospective cohort study was conducted. A total of 1936 HIV-1–infected treatment-naive patients in the clinic of the infectious department, Guangzhou Eighth People’s Hospital, between August 2018 and December 2019 were assayed for PDR mutations before initiating ART. Patients with PDR mutations (PDR arm) were screened and compared with those without drug-resistant mutations (non-PDR arm). The rate of HIV-1 virologic failure (VF) and CD4+ T-cell counts of the 2 arms were compared at the 96th week after ART to evaluate the impact of PDR on the efficacy of ART.ResultsPretreatment drug resistance was detected in 125 cases (6.46%) from the 1936 enrolled participants, most of which were resistant to non-nucleoside reverse transcriptase inhibitors (64.00%, 80/125). One hundred and eight of 125 completed the follow-up of 96 weeks (PDR arm). In this cohort, 52 patients whose ART regimen containing the resistant drug were grouped as con-PDR arm, and the remaining 56 patients whose ART regimen did not contain the resistant drug were grouped as non- con-PDR arm. A total of 125 patients without PDR were randomly selected as the control group (non-PDR arm), 112 of whom had completed the 96-week follow-up. At the 96th week after ART initiation, 7 patients (6.5%, 7/108) in the PDR arm and 1 patient (0.9%, 1/112) in the non-PDR arm developed VF, exhibiting a significant difference (χ2 = 4.901, P = 0.029). Meanwhile, 3 patients (5.8%, 3/52) in the con-PDR arm developed VF; the rate was also higher than that in the non-PDR arm, but without a significant difference (χ2 = 3.549, P = 0.095). The CD4+ T-cell count in the non-PDR arm increased more than the PDR arm (386.6 vs. 319.1 cells/μL, t = 2.448, P = 0.015) or the con-PDR arm (386.6 vs. 325.1 cells/μL, t = 1.821, P = 0.070) at 12 weeks after ART. However, no significant differences were observed in the CD4+ T-cell count from the 24th week after ART onward.ConclusionsPretreatment drug resistance was moderately prevalent in Guangdong, China, and could affect the antiretroviral efficacy during a 96-week observation period, indicating the need to closely monitor PDR before ART initiation.

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Pretreatment drug resistance in people living with HIV: A large retrospective cohort study in Chongqing, China

Cited by 13 publications

References 26 publications

HIV-1 pretreatment drug resistance and genetic transmission network in the southwest border region of China

HIV-1 pretreatment drug resistance and genetic transmission network in the southwest border region of China

Prevalence of HIV Transmitted Drug Resistance in Nanjing from 2018 to 2021

Pre-treatment Drug Resistance Could Impact the 96-Week Antiretroviral Efficacy in Treatment-Naive HIV-1–Infected Patients in Guangdong, China

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