HIV-1 drug-resistant mutations and related risk factors among HIV-1-positive individuals experiencing treatment failure in Hebei Province, China

Abstract

Background: To understand HIV-1 drug resistance in 11 prefectures of Hebei Province, China, we implemented a cross-sectional HIV-1 molecular epidemiological survey.

Methods: Blood samples were collected from 122 newly diagnosed drug-naïve HIV-1-positive individuals and 229 antiretroviral therapy (ART)-failure individuals from 11 prefectures in Hebei Province, China. Patient demographic data were obtained via face-to-face interviews using a standardized questionnaire when blood samples were collected. Genotyping of HIV-1 drug resistance (DR) was implemented using an in-house assay.

Results: In this study, the overall prevalence of HIV-1 DR was 35.5%. The prevalence of HIV-1 DR in participants experiencing treatment failure and ART-naïve participants was 51.9 and 5.9%, respectively. Mutations in protease inhibitors, nucleoside reverse transcriptase inhibitors (NRTIs), and non-NRTI (NNRTIs), as well as dual and multiple mutations were extensively seen in participants experiencing treatment failure. The proportions of NNRTI mutations (χ² = 9.689, p = 0.002) and dual mutations in NRTIs and NNRTIs (χ² = 39.958, p < 0.001) in participants experiencing treatment failure were significantly higher than those in ART-naïve participants. The distributions of M184V/I and M41L mutations differed significantly among three main HIV-1 genotypes identified. Viral load, symptoms in the past 3 months, CD4 counts, transmission route, and the duration of ART were found to be associated with HIV-1 DR.

Conclusions: Our results suggest that new prevention and control strategies should be formulated according to the epidemic characteristics of HIV-1-resistant strains in Hebei Province, where antiretroviral drugs are widely used.

Keywords: China; Drug resistance; HIV-1; Mutation; Phylogeny.

Fig. 1

Geographical distribution of participants collected from 11 prefectures in this study. The numbers to the left and right of the “/” denote the participants genotyped and the total participants, respectively. This figure is adapted from open access map: http://wenku.baidu.com/link?url=u_b5Oe5nC1s_dm7nivfQ1VxQcwj9lDMPsoWfHZHGUNJM5IUiv7JnZo1yAWlVx9KbITt2u5tReJ7qPOtnoxeJw3QI1VUewd1m9N56eJSxuHm and figure 1 in Ref. [14] with Microsoft PowerPoint 2016

Fig. 2

The therapy regimens of ART participants in this study. ATV/r atazanavir/r, NFV/r nelfinavir plus ritonavir, LPV/r lopinavir plus ritonavir, 3TC lamivudine, ABC abacavir, AZT zidovudine, D4T stavudine, DDI didanosine, FTC emtricitabine, TDF tenofovir, EFV efavirenz, ETR etravirine, NVP nevirapine