Pretreatment HIV Drug Resistance and the Molecular Transmission Network among HIV-positive 1 Individuals in China in 2022: a Multicenter Observational Study (Preprint)

Abstract

Emerging HIV drug resistance caused by increased usage of ARV could jeopardize the success of standardized HIV management protocols in resource-limited settings.

We characterized PDR among HIV-positive individuals and risk factors in China in 2022.

This cross-sectional study was conducted using two-stage systematic sampling according to the WHO’s surveillance guidelines in eight provincial-level administrative divisions in 2022. Demographic information and plasma samples were obtained from study participants. PDR and molecular transmission networks were analyzed using partial pol region sequences in the Stanford HIV drug resistance database and HIV-TRACE, respectively. Logistic regression was used to identify and estimate factors associated with PDR.

PDR testing was conducted on 2568 participants in 2022. 34.8% (893/2568) were aged 30-49, 81.4% (2091/2568) were male and 3.2% (81/2568) had prior ARV exposure. The prevalence of PDR was 7.4% in reverse RT/PR regions; the prevalence of PDR to NNRTIs, NRTIs, and PIs were 6.3% (163/2568), 1.2% (32/2568) and 0.2% (5/2568), respectively. Prevalence of NNRTIs-related DR was 6.1% (157/2568) for EFV and 6.3% (163/2568) for NVP. The prevalence of PDR was 11.4% and the prevalence of PDR to NNRTIs was 10.3% in Yunnan. Multivariable logistic regression models indicated that PDR was significantly associated with prior ARV exposure (OR: 7.45, 95% CI: 4.50-12.34) and HIV subtype was CRF55_01B (OR: 2.61, 95% CI: 1.41-4.83). Among 618 (24.2%) sequences (nodes) associated with 253 molecular transmission clusters (size range: 2-13), The percentage of individuals without PDR strains and with PDR strains belonging to a cluster were 20.0% (38/190) and 24.5% (580/2365) (P＞0.05). CRF07_BC 46.6% (288/618) was the predominant subtype among the sequences in the molecular transmission network.

The overall prevalence of PDR in China in 2022 was modest. Targeted genotypic PDR testing and medication compliance interventions must be urgently expanded to address PDR among newly diagnosed people living with HIV in China.