Experience in Diagnostic of HIV Drug Resistance in the Mekong Delta Region, Vietnam: A Comparative Analysis Before and After the COVID-19 Pandemic

Abstract

Background: Vietnam has made significant strides in reducing the prevalence of HIV infection and achievements in its antiretroviral treatment program. However, the COVID-19 pandemic and financial challenges in the healthcare system have posed significant obstacles to maintaining effective HIV treatment and monitoring, particularly among vulnerable populations. This study aims to evaluate the situation of HIV drug resistance among patients who have experienced treatment failure in the Mekong Delta region and to compare data from 2019 to 2022. Methods: The study material was blood plasma samples from HIV-infected individuals with ART failure: 316 collected in 2019 and 326 collected in 2022. HIV-1 genotyping and mutation detection were performed based on an analysis of the nucleotide sequences of the Pol gene region. A total of 116 HIV-infected individuals with virological failure in 2019 and 2022 were assessed for HIV drug resistance. Results: The study revealed a high proportion of participants with viral loads exceeding 1000 copies/mL, significantly increasing from 12.0% in 2019 to 23.9% in 2022 (OR = 2.3; p = 0.0001). HIV drug resistance mutations were detected in 84.21% of cases in 2019 and 92.59% in 2022. The prevalence of concurrent resistance to NRTIs and NNRTIs was 37.5% and 30.13% in 2019 and 2022, respectively. There was a statistically significant decrease in NNRTI resistance (OR = 0.32, χ² = 5.43, p < 0.05). In contrast, multi-drug resistance to protease inhibitors rose from 18.52% to 45.21% (φ* = 0.00403, p < 0.05). Triple-class resistance was identified only in 2022 (17.81%). The most common mutations included M184I/V, D67N, K103N, Y181C, and V82A/S/T, with D67N rising significantly from 3.13% to 21.92%. The predominant subtype was CRF01_AE. Conclusion: A high prevalence of viral non-suppression and HIV drug resistance was observed among patients in the Mekong Delta region, particularly after the onset of the COVID-19 pandemic. Our study highlights the ongoing challenges that the HIV/AIDS treatment program in Vietnam must address in the post-pandemic period to sustain its success and achieve the goals of the country's HIV prevention strategies.

Keywords: HIV drug resistance mutation; HIV-1; NNRTI; NRTI; PI; Vietnam; virological failure.

Figure 1

Ratio of examined patients with different first- and second-line ART regimens in different years of material collection. (A) First line of ART; (B) second line of ART.

Figure 2

Ratio of patients with different first- and second-line ART regimens by year of treatment initiation. (A) First line of ART; (B) second line of ART.

Figure 3

Phylogenetic analysis of viral nucleotide sequences (HIV Pol gene fragment) from HIV-infected persons in Vietnam relative to GenBank reference sequences. Reference sequences are designated as “ref” and indicate the sample genotype. Strains are marked as follows: black circles—reference sequences from GenBank; white circles—studied in this work sequences. Bootstrap values ≥ 70% are given.

Figure 4

Frequency of HIV variants resistant to different classes of antiretroviral drugs and their combinations.

Figure 5

Occurrence of ARP resistance in patients with different ART regimens with one line of treatment.

Figure 6

Occurrence of ARP resistance in patients with different ART regimens with two lines of treatment.

Figure 7

The proportion of resistance mutations for different drug classes among the total diversity of mutations identified.

Figure 8

Occurrence of the most common drug resistance mutations for NRTIs and NNRTIs.

Figure 9

Line charts showing observed patterns of drug resistance mutations for NRTIs. Vertical bars represent DRM profiles. Horizontal marks represent a specific mutation in the profile. Bold underlines indicate major mutations. *: mutations to NRTIs, **: mutations to NNRTIs, ***: mutations to PIs. (A) 2019; (B) 2022.

Figure 9

Line charts showing observed patterns of drug resistance mutations for NRTIs. Vertical bars represent DRM profiles. Horizontal marks represent a specific mutation in the profile. Bold underlines indicate major mutations. *: mutations to NRTIs, **: mutations to NNRTIs, ***: mutations to PIs. (A) 2019; (B) 2022.