Prevalence of HIV Transmitted Drug Resistance in Nanjing from 2018 to 2021

Abstract

Background

Transmitted drug resistance (TDR) is a major challenge in the clinical management of acquired immunodeficiency syndrome (AIDS). Therefore, this study aimed to investigate the epidemic characteristics of and risk factors for human immunodeficiency virus (HIV)-1 TDR in Nanjing from 2018 to 2021 to provide support for clinical management.

Methods

The HIV-1 Pol gene was amplified by nested reverse transcription polymerase chain reaction from venous blood of 1190 HIV-infected patients who did not receive antiviral therapy, and the amplified product was sequenced using an in-house sequencing method. The sequencing result was compared with the HIV drug resistance database from Stanford University to elucidate the rates of antiviral drug resistance and distribution of drug-resistant mutation sites. Factors associated with TDR were evaluated using a logistic regression model.

Results

Detection of drug resistance at the gene level was successful in 1138 of 1190 HIV-1-infected patients (95.6%), and the overall 4-year drug resistance rate was 8.2% (93/1138). The drug resistance rate was higher for non-nucleoside reverse transcriptase inhibitors (NNRTIs; 6.7%) than for nucleoside reverse transcriptase inhibitors (NRTIs; 2.5%) or protease inhibitors (PIs; 0.1%) (χ² = 83.907, P<0.0001). The most common NNRTI-related mutation was V179D/E followed by K103N. M184V was the dominant NRTI-associated mutation, and M46L/I was the most prevalent PI-associated mutation. A CD4⁺ T cell count of <50 cells/μL was significantly associated with an increased risk of TDR (OR=3.62, 95% CI: 1.38–9.51, P=0.009).

Conclusion

The prevalence of TDR in the city of Nanjing from 2018 to 2021 was at a moderate epidemic risk according to World Health Organization standards. Continuous monitoring of TDR can inform clinical diagnosis and treatment. Patients with advanced disease and a low CD4⁺ T lymphocyte count are more likely to have TDR in Nanjing.

Keywords:

• HIV-1
• transmitted drug resistance
• mutation sites

Abbreviations

3TC, lamivudine; ABC, abacavir; ATV/r, atazanavir/ ritonavir; AZT, zidovudine; CRF, circulating recombinant form; CI, confidence interval; DTG, dolutegravir; DOR, doravirine; DRV/r, denavir/ritonavir; EFV, efavirenz; ETR, etravirine; FTC, emtricitabine; IDU, intravenous drug use; LPV/r, lopinavir/ ritonavir; NNRTI, non-nucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; NVP, nevirapine; OR, odds ratio; PCR, polymerase chain reaction; PI, protease inhibitor; RPV, rilpivirine; TDF, tenofovir disoproxil fumarate; TDR, transmitted drug resistance.

Data Sharing Statement

The datasets analyzed during the current study are available from the corresponding author Hongxia Wei upon reasonable requests.

Ethics Approval and Consent to Participate

The study protocol was approved by the Medical Ethics Committee of The Second Hospital of Nanjing (approval number: 2018-LY-kt027; approval date: 9 May, 2018), and all subjects provided written informed consent. The study was conducted in accordance with the Declaration of Helsinki.

Acknowledgments

We thank all the participants in the study. We also thank the staff of The Second Hospital of Nanjing for facilitating access to the relevant medical records. And we are grateful to the AIDS Healthcare Foundation for their support of our work.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that there are no competing interests associated with this study.

Additional information

Funding

This work was supported by the 2020 Annual Medical Research Project of Jiangsu Commission of Health, awarded to Hongxia Wei [Grant# ZDA 2020014], and the Key Project supported by Medical Science and Technology Development Foundation, Nanjing Department of Health, awarded to Hongxia Wei (Grant# ZKX 22040) and awarded to Hongying Zhang (Grant# ZKX 19048).