Infection and Drug Resistance (Feb 2023)

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

  • Su Y,
  • Qi M,
  • Zhong M,
  • Yu N,
  • Chen C,
  • Ye Z,
  • Cheng C,
  • Hu Z,
  • Zhang H,
  • Wei H

Journal volume & issue
Vol. Volume 16
pp. 735 – 745

Abstract

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Yifan Su,1 Mingxue Qi,1 Mingli Zhong,2 Nawei Yu,1 Chen Chen,1 Zi Ye,1 Cong Cheng,1 Zhiliang Hu,1 Hongying Zhang,3 Hongxia Wei1 1Department of Infectious Disease, The Second Hospital of Nanjing Affiliated to Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China; 2Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China; 3Nanjing Center for Disease Control and Prevention Affiliated with Nanjing Medical University, Nanjing, People’s Republic of ChinaCorrespondence: Hongxia Wei, Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, People’s Republic of China, Email [email protected] Hongying Zhang, Email [email protected]: 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%) (χ2 = 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.Keywords: HIV-1, transmitted drug resistance, mutation sites

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