Epidemiological surveillance of HIV-1 transmitted drug resistance among newly diagnosed individuals in Shijiazhuang, northern China, 2014–2015

Wang, Xianfeng; Liu, Xiaosong; Feng, Luzhao; Zhou, Hong; Li, Jiefang; Wang, Yingying; Liu, Lihua; Liu, Shujun; Feng, Yi; Wang, Ning

doi:10.1371/journal.pone.0198005

Cited by 15 publications

(12 citation statements)

References 41 publications

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“…As the increase in TDR will affect the antiviral treatment and the spread of drug resistance, the surveillance of TDR should be strengthened, and measures to curb the increase of TDR should be adopted. A significant difference was observed between the prevalence of TDR and marital status and subtype, which contradicted from the results of a previous study [ 17 , 28 ]. When marital status was used as a categorisation parameter, unmarried individuals were most likely to develop drug resistance.…”

Section: Discussioncontrasting

confidence: 94%

HIV drug resistance and HIV transmission risk factors among newly diagnosed individuals in Southwest China

Pang

Tang

et al. 2021

BMC Infect Dis

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Background The widespread use of antiretroviral therapy (ART) has resulted in the development of transmitted drug resistance (TDR), which reduces ART efficacy. We explored TDR prevalence and its associated risk factors in newly diagnosed individuals in Guangxi. Methods We enrolled 1324 participants who were newly diagnosed with HIV-1 and had not received ART at voluntary counselling and testing centres (VCT) in Guangxi, China, who had not received ART. Phylogenetic relationship, transmission cluster, and genotypic drug resistance analyses were performed using HIV-1 pol sequences. We analysed the association of demographic and virological factors with TDR. Results In total, 1151 sequences were sequenced successfully, of which 83 (7.21%) showed evidence of TDR. Multivariate logistic regression analysis revealed that there was significant difference between the prevalence of TDR and unmarried status (adjusted odds ratio (aOR) = 2.41, 95% CI: 1.23–4.71), and CRF08_BC subtype (aOR = 2.03, 95% CI: 1.13–3.64). Most cases of TDR were related to resistance to non-nucleoside reverse transcriptase inhibitors (4.87%) and V179E was the most common mutation detected. We identified a total of 119 HIV transmission clusters (n = 585, 50.8%), of which 18 (15.1%) clusters showed evidence of TDR (36, 41.86%). Three clusters were identified that included drug-resistant individuals having a transmission relationship with each other. The following parameters were associated with TDR transmission risk: Unmarried status, educational level of junior high school or below, and CRF08_BC subtype may be a risk of the transmission of TDR. Conclusions Our findings indicated that moderate TDR prevalence and highlighted the importance of continuous TDR monitoring and designing of strategies for TDR mitigation.

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Section: Discussioncontrasting

confidence: 94%

HIV drug resistance and HIV transmission risk factors among newly diagnosed individuals in Southwest China

Pang

Tang

et al. 2021

BMC Infect Dis

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“…However, drug resistance and clustering in the transmission network were independent of each other, which is consistent with the results of a study in Shijiazhuang [ 71 ]. The clusters containing drug-resistant individuals in the genetic transmission network accounted for 13.5% of the study population, and the proportion increased over time, which may be caused by an increase in the number of drug-resistant individuals over time.…”

Section: Discussionsupporting

confidence: 90%

Survey of Pretreatment HIV Drug Resistance and Genetic Transmission Network Analysis Among HIV Patients in a High Drug-Use Area of Southwest China

Liu¹,

Dong²,

Liao³

et al. 2020

CHR

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Background: Pretreatment drug resistance (PDR) poses an increasing threat to the success of antiretroviral treatment (ART) programs in China. We aimed to conduct a survey of PDR among HIV patients in an area in Southwest China with extensive drug trafficking. Methods: Consecutive cross-sectional surveys were conducted in Liangshan Prefecture of Sichuan Province from 2009 to 2018 based on the WHO-recommended method. PDR was identified by testing pol region sequences with the Stanford HIVdb algorithm (version 7.0). PDR prevalence and related factors were assessed by multivariable logistic regression. The transmission of HIV drug resistance was analyzed using a genetic transmission network. Results: HIV-1 pol genes from 1889 patients were successfully amplified. The distribution of HIV- 1 genotypes was as follows: CRF07_BC (94.0%), CRF08_BC (2.3%), CRF01_AE (2.0%) and others (1.4%). Of the participants, 6.9% (95% CI: 4.1-8.1%) had pretreatment resistance to 12 antiretroviral drugs recommended by the WHO, and nucleoside reverse transcriptase inhibitor (NRTI), non-nucleoside reverse transcriptase inhibitor (NNRTI) and protease inhibitors (PI) resistance were identified among 1.4% (95% CI: 0.7-3.4%), 5.8% (95% CI: 1.2-8.7%) and 0.4% (95% CI: 0.1- 3.0%) of the patients, respectively. In the multivariate logistic model, the prevalence of PDR was 1.52-fold higher among intravenous drug users (IDUs) than among patients infected by heterosexual transmission (95% CI: 1.07-2.38; P=0.049), and the prevalence of PDR among patients diagnosed from 2017-2018 was 2.03-fold higher than that among patients diagnosed from 2009-2016 (95% CI: 1.18-5.76; P=0.018). A total of 26 clusters containing PDR and a rapidly growing drug resistancerelated cluster containing the E138Q and V179D mutations were identified by genetic transmission network analysis. Conclusions: The results show a moderate overall level of PDR prevalence and rapidly growing drug resistance over time. Preventive intervention should be focused on controlling the HIV epidemic among drug users, and surveillance is urgently needed to monitor the trend of PDR.

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“…The RT K103N mutation found in two strains can reduce EFV and NVP susceptibility by about 20-and 50-fold, respectively 44 . Drug resistance analysis demonstrated that 2.4% of HIV-1 isolates contained at least one NNRTI (K101E, K103N) or PI (M46I) SDRMs, the overall prevalence of TDR was lower than previous reports in Zhejiang (11.1%) and Shijiazhuang (6.1%) among treatment-naïve HIV-infected individuals 45,46 , but similar to a nationwide cross-sectional survey about prevalence of TDR (3.6%) in 2015 in China 47 . Although the rate of TDR remained relatively low in Chinese blood donors in this study, the detection of 3 major NNRTI mutations and 1 PI mutation underlined the importance of a continuous surveillance of resistance mutations.…”

Section: Discussionsupporting

confidence: 69%

HIV-1 molecular epidemiology and drug resistance-associated mutations among treatment-naïve blood donors in China

Zhao

Chang

et al. 2020

Sci Rep

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Surveillance of human immunodeficiency virus (HIV) molecular diversity and drug resistance-associated mutations (DRMs) among treatment-naïve blood donors is critical for monitoring viral evolution and blood safety. From 2016-2017, 199 plasma samples were collected from 24 blood centers and confirmed as HIV viral load positive or serologically reactive in National Centers for Clinical Laboratories (NCCL), of which 179 were sequenced and subtyped in the gag, protease (PR)-reverse transcriptase (RT), integrase (IN) and/or envelope (env) regions. DRMs in PR-RT and IN regions were analyzed in Stanford HIVdb Program. The majority of subtypes were circulating recombinant form (CRF) 07_BC (34.6%) and CRF01_ AE (32.4%); many unique recombinant forms (URFs) (39, 21.8%) and other rare CRFs were observed in the study. Notably, CRF02_AG and CRF06_cpx strains typically found in Africa were firstly identified amongst Chinese blood donors. DRMs were common, with 28 of 179 (15.6%) specimens carrying DRMs, including the PR N88S and RT K103N mutations, which have been implicated in elevated resistance to antiretroviral drugs. Furthermore, 4 HIV-1 isolates (2.4%, 4/168) had surveillance drug-resistance mutation (SDRM), including 3 nonnucleosidereverse transcriptase inhibitors (NNRTI) SDRMs (1 K101E, 2 K103N) and 1 protease inhibitor (PI) SDRM (M46I). The HIV viral diversity among blood donors observed in this study suggest that ongoing HIV-1 recombination is becoming progressively complex in China, and lots of DRMs found in the study exacerbate the primary drug resistance landscape, which highlight the necessity of timely genotypic drug resistance monitoring and molecular surveillance of HIV-1 among blood donors. According to a recent report from the National Center for Acquired Immunodeficiency Syndrome/Sexually Transmitted Disease (AIDS/STD) Control and Prevention (China CDC), there were approximately 849,602 people living with HIV and 262,442 reported HIV-associated deaths in China as of September, 2018 1. Epidemiological evidence indicates that the HIV epidemic has shifted from high risk populations into general populations in China, including blood donors 2,3. In 2003, the "Four Frees and One Care" policy was implemented to reduce AIDS-related mortality in China by providing free antiretroviral drugs, including highly active antiretroviral therapy 4. However, the effectiveness of antiretroviral therapy (ART) may be limited by the transmission of HIV drug resistant strains to ART-naïve patients 5 , which is a major obstacle to viral suppression 6,7. Therefore, the World Health Organization strongly recommends surveillance of transmitted drug resistance (TDR) amongst HIV infected populations 8. Characterization of HIV genetic diversity and TDR among volunteer blood donors (treatment-naïve populations) is essential for monitoring viral evolution and optimal ART selection, both have important roles in blood safety 9. Moreover, viral diversity has the potential to impact the sensitivity and accuracy of HIV blood screening tests, pot...

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Epidemiological surveillance of HIV-1 transmitted drug resistance among newly diagnosed individuals in Shijiazhuang, northern China, 2014–2015

Cited by 15 publications

References 41 publications

HIV drug resistance and HIV transmission risk factors among newly diagnosed individuals in Southwest China

HIV drug resistance and HIV transmission risk factors among newly diagnosed individuals in Southwest China

Survey of Pretreatment HIV Drug Resistance and Genetic Transmission Network Analysis Among HIV Patients in a High Drug-Use Area of Southwest China

HIV-1 molecular epidemiology and drug resistance-associated mutations among treatment-naïve blood donors in China

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