An analysis of drug resistance among people living with HIV/AIDS in Shanghai, China

Abstract

BackgroundUnderstanding the mechanisms of drug resistance can facilitate better management of antiretroviral therapy, helping to prevent transmission and decrease the morbidity and mortality of people living with HIV/AIDS. However, there is little data about transmitted drug resistance and acquired drug resistance for HIV/AIDS patients in Shanghai.MethodsA retrospective cohort study of HIV-infected patients who visited the Department of Infectious Disease from June 2008 to June 2015 was conducted in Shanghai, China. Logistic regression analysis was performed to analyze risk factors for drug resistance among HIV-infected people with virological failure. The related collected factors included patient age, gender, marital status, infection route, baseline CD4 count, antiretroviral therapy regimens, time between HIV diagnosis and initiating antiretroviral therapy. Factors with p<0.1 in the univariate logistic regression test were analyzed by multivariate logistic regression test.ResultsThere were 575 subjects selected for this study and 369 participated in this research. For the antiretroviral therapy drugs, the rates of transmitted drug resistance and acquired drug resistance were significantly different. The non-nucleoside reverse transcriptase inhibitor (NNRTI) had the highest drug resistance rate (transmitted drug resistance, 10.9%; acquired drug resistance, 53.3%) and protease inhibitors (PIs) had the lowest drug resistance rate (transmitted drug resistance, 1.7%; acquired drug resistance, 2.7%). Logistic regression analysis found no factors that were related to drug resistance except marital status (married status for tenofovir: odds ratio = 6.345, 95% confidence interval = 1.553–25.921, P = 0.010) and the time span between HIV diagnosis and initiating antiretroviral therapy (≤6M for stavudine: odds ratio = 0.271, 95% confidence interval = 0.086–0.850, P = 0.025; ≤6M for didanosine: odds ratio = 0.284, 95% confidence interval = 0.096–0.842, P = 0.023; ≤6M for tenofovir: odds ratio = 0.079, 95% confidence interval = 0.018–0.350,P<0.001).ConclusionNNRTI had a higher DR rate compared with nucleoside reverse transcriptase inhibitor (NRTI) and PIs, consequently, LPV/r was a reasonable choice for patients with NNRTI drugs resistance in China. Only married status and a time span≤6 month between the HIV confirmed date and the time initiating antiretroviral therapy were risk factors for TDF drug resistance. Both baseline HIV-RNA load and resistance test is crucial for TDR diagnosis, and frequent monitoring of HIV-RNA load is crucial for ADR identification and intervention. Treatment adherence still plays a positive role on the outcome of ART.

Characteristics of HIV-1 Molecular Transmission Networks and Drug Resistance Among Men Who Have Sex with Men in Tianjin, China (2014-2018)

“…In China, the regimen composed of TDF, 3TC, and EFV is currently the most commonly used free rst-line therapy [32] . Our study highlights that DRMs affecting the e cacy of NNRTIs are the most common, followed by those of NRTIs and PIs, which is consistent with results of domestic and foreign studies [33][34][35] . Related studies in the USA showed that the K103N mutation was the most common, and its generation and transmission were related to the failure of early antiviral therapy caused by patients' longterm and frequent use of the NNRTI drug efavirenz [36] .…”

Optimizing Treatment for Adults with HIV/AIDS in China: Successes over Two Decades and Remaining Challenges

“…However, uneven geographic distribution of resistance has been reported, and certain areas have shown exceptionally high rates of TDR. A retrospective cohort study in Shanghai from 2008 to 2015 reported high rates of TDR, with the highest drug resistance rate found among NNRTIs at 10.9% [37]. Similarly, a cross-sectional study in Zhejiang province showed a TDR rate of 11.1% among treatment-naïve HIV-infected individuals during 2014-2017 [38].…”

“…The emergence of acquired drug resistance (ADR) is mainly related to poor patient adherence or to selection pressure on HIV quasi-species of the initial ART regimen [39]. ADR is the primary driver of treatment failure, and studies have found rates of ADR to any-class drugs reached as high as 50-60% among treatment-failure individuals in certain regions of China [37,40]. Therefore, enhanced education and monitoring with regard to adherence, and adequate intervals of viral surveillance, especially in the first year of treatment, play an essential role in the control of ADR.…”

Prevalence of acquired drug resistance mutations in antiretroviral- experiencing subjects from 2012 to 2017 in Hunan Province of central South China

“…Drug resistance can be categorized into ADR mutations in treatment-experienced patients and transmitted drug resistance (TDR) mutations in treatment-naïve individuals, both of which could cause the failure of the antiretroviral therapy (ART). Ignoring TDR can result in treatment failure of antiretroviral regimens, and ADR is often associated with virological failure (VF) and can increase the burden of treatment [3,4]. While TDR has been well documented, fewer studies report on the rates of ADR.…”