HIV drug resistance in patients in China’s national HIV treatment programme who have been on first-line ART for at least 9 months

Liu, Pengtao; Xing, Hui; Liao, Lingjie; Feng, Yi; Leng, Xuebing; Wang, Jing; Kan, Wei; Yan, Jing Jou; Li, Yang; Zuo, Zhongbao; You, Yinghui; Ruan, Yuhua; Shao, Yiming

doi:10.1186/s12981-020-00264-5

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…With the increase in the number of people receiving antiviral treatment, the risk of HIV drug resistance also increases, which may lead to the increase the transmissible drug resistance rate, it directly affects the effect of antiviral therapy. The drug resistance survey results of infected people receiving antiviral treatment showed that the national acquired drug resistance rate was 8.6% [54], and the drug resistance rate of infected people who fail to inhibit the virus exceeds 50% [55,56]. TDR was less frequent among individuals involved in clusters (1.95%) compared with those out of clusters (6.23%), which might be explained by several factors.…”

Section: Discussionmentioning

confidence: 99%

Characterization of HIV-1 molecular epidemiology and transmitted drug-resistance in newly diagnosed HIV-infected patients in Sichuan, China

Zhou

Liang

et al. 2022

BMC Infect Dis

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Background Sichuan province is one of the highest AIDS epidemic provinces in China, with a large number of floating population. The annual number of cases of HIV/AIDS reported in Sichuan has been the highest province in China for several successive years. There is a lack of widespread and representative data on the distribution of HIV genotypes in Sichuan. We aim to investigate the characteristics of HIV-1 molecular epidemiology and transmitted drug-resistance in newly diagnosed HIV-infected patients in Sichuan, China. Method Archived plasma samples (n = 1524) from HIV-1 newly-diagnosed individuals in April 2019 were selected by cross-sectional investigation from all 21 cities in Sichuan province. Phylogenetic relationship, transmission cluster, and genotypic drug resistance analyses were performed using HIV-1 polymerase (pol) gene sequences. We also analysed the association of demographic and virological factors with transmitted drug-resistance (TDR) and transmission clusters. Results Partial pol gene sequences were obtained from 1297 cases. HIV-1 epidemic strains in Sichuan province: the majority of genotypes were circulating recombinant form (CRF) 07_BC (675, 52.04%), CRF01_AE (343, 26.45%), CRF08_BC (115, 8.87%), CRF85_BC (67, 5.17%), subtype B (33, 2.54%), the other genotypes only accounted for 4.93%, and unique recombinant forms (URFs) (23, 1.77%) were observed in the study, and the difference of age, ethnicity, education, occupation, region and transmission pathway of different genotypes were statistically significant. According to WHO HIVDR surveillance threshold, the level of TDR has reached a medium level, with 72 of 1297 (5.55%) cases carrying drug-resistance mutation sites, TDR mutation frequency to nonnucleoside reverse transcriptase inhibitors (NNRTIs, 3.85%) was much higher than nucleoside reverse transcriptase inhibitors (NRTIs, 0.31%) and protease inhibitors (PIs, 1.70%), and CRF08_BC was a risk factor for TDR (odds ratio, 8.32; 95% CI 4.38–15.80 for CRF07_BC, P < 0.05). The most common drug resistance HIV-1 mutation pattern for NNRTI was V106 (1.31%, 17/1297) and E138 (1.16%, 15/1297), and for PI was M46 (0.69%, 9/1297). A total of 205 (15.8%) pol sequences were involved in the genetic transmission network clusters, CRF01_AE (odds ratio, 2.369; 95% CI 1.659–3.382; P < 0.05), subtype B (odds ratio, 13.723; 95% CI 6.338–29.71; P < 0.05), drug resistance (odds ratio, 0.306; 95% CI 0.106–0.881; P < 0.05) and different levels of education (P < 0.05) were significantly associated to be in clusters. Conclusion The distribution of HIV-1 genotypes in Sichuan is more diverse and complex, and the Men who have sex with men (MSM) is underrated, arguing for behavior scaling up intervention in this specific population besides the elderly people with heterosexual transmission risk groups. The risk of TDR mutation frequency increased in newly diagnosed patients highlights the significance of genotypic drug resistance monitoring and molecular surveillance of pretreatment HIV-1 drug resistance. The regimen composed of TDF, 3TC and EFV was still currently the preferred solution used free first-line therapy.

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Section: Discussionmentioning

confidence: 99%

Characterization of HIV-1 molecular epidemiology and transmitted drug-resistance in newly diagnosed HIV-infected patients in Sichuan, China

Zhou

Liang

et al. 2022

BMC Infect Dis

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“…Clinical interventions are initiated upon detection of VL > 50 copies/mL in developed countries where frequent VL monitoring is performed, and the LLV is considered in the range of 50–200 copie/mL [ 33 ]. It should be noted that the definition of LLV remains 50–999 copies/mL in China, because most commercial resistance assays can only be performed on samples with VL above a minimum of 500–1000 copies/mL [ 19 , 27 , 34 , 35 ]. We conducted a systematic nationwide survey of HIVDR in patients with VL 50–999 copies/mL in China, and compared the results with those with VL ≥ 1000 copies/mL.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, available studies from China performed integrase genotyping only on samples with VL ≥ 1000 copies/mL, few data are available on the emergence of such mutations in patients with LLV [ 22 – 25 ]. In recent years, in-house resistance assays can be performed on samples with VL below 1000 copies/mL, and the improvement of assays to quantify VL has led to progressively decrease the threshold of VF [ 7 , 21 , 26 , 27 ]. The high threshold for VF currently used in NFATP should be reconsidered.…”

Section: Introductionmentioning

confidence: 99%

Impact of low-level viremia with drug resistance on CD4 cell counts among people living with HIV on antiretroviral treatment in China

et al. 2022

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Background Maintaining plasma HIV RNA suppression below the limit of quantification is the goal of antiretroviral therapy (ART). When viral loads (VL) remain in low-level viremia (LLV), or between 201 and 999 copies/mL, the clinical consequences are still not clear. We investigated the occurrence of LLV with drug resistance and its effect on CD4 cell counts in a large Chinese cohort. Methods We analysed data of 6,530 ART-experienced patients (42.1 ± 10.9 years; 37.3% female) from the China’s national HIV drug resistance (HIVDR) surveillance database. Participants were followed up for 32.9 (IQR 16.7–50.5) months. LLV was defined as the occurrence of at least one viral load (VL) measurement of 50–200 copies/mL during ART. Outcomes were drug resistance associated mutations (DRAM) and CD4 cell counts levels. Results Among 6530 patients, 58.0% patients achieved VL less than 50 copies/mL, 27.8% with VL between 50 and 999 copies/mL (8.6% experienced LLV), and 14.2% had a VL ≥ 1000 copies/mL. Of 1818 patients with VL 50–999 copies/mL, 182 (10.0%) experienced HIVDR, the most common DRAM were M184I/V 28.6%, K103N 19.2%, and V181C/I/V 10.4% (multidrug resistance: 27.5%), and patients with HIVDR had a higher risk of CD4 cell counts < 200 cells/μL (AOR 3.8, 95% CI 2.6–5.5, p < 0.01) comparing with those without HIVDR. Of 925 patients with VL ≥ 1000 copies/mL, 495 (53.5%) acquired HIVDR, the most common DRAM were K103N 43.8%, M184I/V 43.2%, M41L 19.0%, D67N/G 16.4%, V181C/I/V 14.5%, G190A/S 13.9% and K101E 13.7% (multidrug resistance: 75.8%), and patients with HIVDR had a higher risk of CD4 cell counts < 200 cells/μL (AOR 5.8, 95% CI 4.6–7.4, p < 0.01) comparing with those without HIVDR. Conclusion Persistent with VL 50–999 copies/mL on ART is associated with emerging DRAM for all drug classes, and patients in this setting were at increased risk of CD4 cell counts < 200 cells/μL, which suggest resistance monitoring and ART optimization be earlier considered.

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“…It could be seen that the longer the antiviral time, the higher the proportion of drug resistance. With the increase in the number of people receiving antiviral treatment, the risk of HIV drug resistance also increases, which may lead to the increase the transmissible drug resistance rate, it directly affects the effect of antiviral therapy.The drug resistance survey results of infected people receiving antiviral treatment showed that the national acquired drug resistance rate was 8.6% [50], and the drug resistance rate of infected people who fail to inhibit the virus exceeds 50% [51,52].…”

Section: Discussionmentioning

confidence: 99%

Characterization of HIV-1 molecular epidemiology and Transmitted drug-resistance in newly diagnosed HIV-infected patients in Sichuan, China

Zhou

Liang

et al. 2021

Preprint

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Background Sichuan Province is one of the highest AIDS epidemic provinces in China, with a large number of floating population. The annual number of cases of HIV/AIDS reported in Sichuan has been the highest province in China for several successive years. There is a lack of widespread and representative data on the distribution of HIV subtypes in Sichuan. We aim to investigate the characteristics of HIV-1 molecular epidemiology and transmitted drug-resistance in newly diagnosed HIV-infected patients in Sichuan, China. Method Archived plasma samples (n = 1524) from HIV-1 newly-diagnosed individuals in April 2019 were selected by cross-sectional investigation from all 21 cities in Sichuan Province. Phylogenetic relationship, transmission cluster, and genotypic drug resistance analyses were performed using HIV-1 polymerase (pol) gene sequences. We also analysed the association of demographic and virological factors with transmitted drug-resistance (TDR). Results Partial pol gene sequences were obtained from 1297 cases. HIV-1 epidemic strains in Sichuan province: the majority of subtypes were circulating recombinant form (CRF) 07_BC (675, 52.04%), CRF01_AE (343, 26.45%), CRF08_BC (115, 8.87%), CRF85_BC (67, 5.17%), subtype B (33, 2.54%), the other subtypes only accounted for 4.93%, and circulating recombinant forms (URFs) (23, 1.77%) were observed in the study, and the difference of age, ethnicity, education, occupation, region and transmission pathway of different subtypes were statistically significant, CRF08_BC was significantly drug-resistant. A total of 205 (43.78%) pol sequences were involved in the genetic transmission network, with 76 clusters ranging in size from 2 to 24 pol sequences. In addition, the level of TDR has reached a medium level, with 72 of 1297 (5.55%) cases carrying drug-resistance mutation sites, TDR mutation frequency to nonnucleoside reverse transcriptase inhibitors (NNRTIs, 3.85%) was much higher than nucleoside reverse transcriptase inhibitors (NRTIs, 0.31%) and protease inhibitors (PIs, 1.70%). The most common HIV-1 mutation pattern for NNRTI was V106 (1.31%, 17/1297) and E138 (1.16%, 15/1297), and for PI was M46 (0.69%, 9/1297). Conclusion The distribution of HIV-1 genotypes in Sichuan is more diverse and complex, and the Men who have sex with men (MSM) is underrated, arguing for behavior scaling up intervention in this specific population besides the elderly people with heterosexual transmission risk groups. The risk of TDR mutation frequency increased in newly diagnosed patients highlights the significance of genotypic drug resistance monitoring and molecular surveillance of pretreatment HIV-1 drug resistance. The regimen composed of TDF, 3TC and EFV was still currently the preferred solution used free first-line therapy.

show abstract

HIV drug resistance in patients in China’s national HIV treatment programme who have been on first-line ART for at least 9 months

Cited by 7 publications

References 22 publications

Characterization of HIV-1 molecular epidemiology and transmitted drug-resistance in newly diagnosed HIV-infected patients in Sichuan, China

Characterization of HIV-1 molecular epidemiology and transmitted drug-resistance in newly diagnosed HIV-infected patients in Sichuan, China

Impact of low-level viremia with drug resistance on CD4 cell counts among people living with HIV on antiretroviral treatment in China

Characterization of HIV-1 molecular epidemiology and Transmitted drug-resistance in newly diagnosed HIV-infected patients in Sichuan, China

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