HIV-1 subtype distribution and drug resistance profiles among PLWHA with detectable viremia in Henan Province, China, 2023

Categories: Disease & Virus

May 23, 2025

Patient characteristics

A total of 987 PLWHA with detectable viremia after ART were included in this study. Samples from 804 patients were successfully genotyped, giving a detection rate of 81.46%. Among the 804 successfully genotyped individuals, the median age was 49 years (IQR, 34–58), 73.51% (591/804) were male, 56.97% (458/804) were married, and 99.13% (797/804) were of Han ethnicity. The main route of transmission was sexual transmission (61.57%, 495/804), within which MSM accounted for 40.92% (329/804). Farmers accounted for 40.17% (323/804). According to the analysis, those with educational levels below junior college accounted for 68.28% (549/804). Detailed demographic characteristics of the patients are presented in Table 1.

Table 1 Characteristics of PLWHA who presented with detectable viremia after ART in Henan Province, China, 2023.

Genotype distribution

The obtained pol gene sequences were submitted to the REGA online HIV-1 subtype analysis tool for subtype analysis. Furthermore, a phylogenetic tree was constructed based on the pol gene sequences. All determined subtypes clustered with reference strains, indicating accurate subtype classification (Supplementary Fig. 1). A total of 14 subtypes were detected. The subtype with the highest frequency was subtype B (55.97%, 450/804), followed by CRF01_AE (22.14%, 178/804), CRF07_BC (15.42%, 124/804), CRF55_01B (3.36%, 27/804), CRF08_BC (1.00%, 8/804), C (0.62%, 5/804), and other subtypes (1.49%, 12/804), including CRF67_01B (0.50%, 4/804), CRF62_BC (0.25%, 2/804), CRF02_AG (0.12%, 1/804), CRF03_A6B (0.12%, 1/804), CRF52_01B (0.12%, 1/804), CRF59_01B (0.12%, 1/804), CRF68_01B (0.12%, 1/804), and G (0.12%, 1/804) (Table 2).

Table 2 Distribution and prevalence of DRMs among HIV-1 subtypes in PLWHA with detectable viremia after ART.

Characteristics of DR

Among 804 PLWHA with detectable viremia after ART, 545 samples showed low-level or greater resistance to at least one ART drug, resulting in a total DR incidence of 67.79% (545/804). The prevalence of DR among PLWHA with the VL of below and ≥ 200 copies/mL were 40.63% (13/32) and 68.91% (532/772), respectively (data not shown). Chi-squared analysis results indicated significant differences in DR incidence rates among different subtypes (Table 2). Further analysis of DRMs revealed that NNRTIs-related mutations had the highest frequency (62.94%, 506/804), with mutation sites dominated by K103 (33.58%), G190 (18.16%), V106 (17.91%), V179 (14.30%), and Y181 (14.05%). NRTIs-related mutations had a frequency of 53.23% (428/804), dominated by M184 (45.90%), K65 (19.28%), K70 (17.41%), S68 (16.04%), and D67 (11.94%). PIs-related mutations had a relatively low frequency of 7.34% (59/804), dominated by M46 (3.73%), V82 (3.23%), and I54 (2.86%). INSTIs-related mutations had the lowest rate (3.98%, 32/804), dominated by E157 (1.37%), G163 (1.00%), and E138 (0.75%) (Fig. 1). Further analysis showed DRMs incidences: 20.90% (168/804) for single-class drugs, 45.77% (368/804) for dual-class drugs, 6.47% (52/804) for triple-class drugs, and 0.37% (3/804) for quadruple-class drugs.

Since over 90% of PLWHA in China were prescribed with free ART drugs, namely abacavir (ABC), zidovudine (AZT), and lamivudine (3TC) of the NRTIs, tenofovir (TDF), efavirenz (EFV), and nevirapine (NVP) of the NNRTIs, and lopinavir/ritonavir (LPV/r) of the PIs, we thus analyzed the DRMs against these seven drugs separately. The results showed that the prevalence of DRMs against the seven drugs is 65.30% (525/804), with ABC at 51.74% (416/804), AZT at 14.43% (116/804), 3TC at 51.12% (411/804), TDF at 37.31% (300/804), EFV at 60.95% (490/804), NVP at 61.32% (493/804), and LPV/r at 4.85% (39/804). For individual drugs, NVP (60.32%, 485/804), EFV (55.22%, 444/804), and 3TC/emtricitabine (FTC) (45.77%, 368/804) showed the highest incidence of high-level resistance. Doravirine (DOR; 21.64%, 174/804), etravirine (ETR; 17.16%, 138/804), and TDF (17.04%, 137/804) have the highest incidence of medium-level resistance. Rilpivirine (RPV; 13.31%, 107/804), ABC (12.69%, 102/804), and TDF (9.95%, 80/804) have the highest incidence of low-level resistance (Fig. 2). Detailed information on the drug resistance of ART drugs related to DRMs are presented in Fig. 2.

Analysis of factors influencing DRMs

Univariate logistic regression analysis found that patients aged 40–49 years old, baseline CD4 < 200 cells/µL, current VL of 10³–10⁵ copies/mL, current CD4 < 100 cells/µL, years of infection ≥ 10 years, and those initially using the NRTI plus NNRTI ART regimen had a higher possibility of developing DR. Further multivariate logistic regression analysis showed that age < 29 years old and 40–49 years old, baseline CD4 < 500 cells/µL, current VL of 10³–10⁵ copies/mL, and the initial ART regimen consisting of NRTI plus NNRTI only were closely related to the occurrence of DR (Table 3).

Table 3 Analysis of influencing factors of DR among PLWHA with detectable viremia after ART.

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