Analysis of Drug Resistance and Molecular Network Among Patients with HIV/AIDS Who Had Virological Failure After Antiretroviral Therapy in Aksu Prefecture,Xinjiang Uygur Autonomous Region,China
Objective to investigate the prevalence and potential factors related with drug resistance among patients with HIV/AIDS who had virologic failure after antiretroviral therapy(ART)from six counties of Aksu prefecture in Xinjiang Uygur Autonomous Region,China and analyze the characteristics of the molecular network of the HIV strains.The blood samples were collected from 2020 to 2021,patients with HIV who received antiviral therapy beyond 6 months and the viral loads≥1000 copies/mL were included.HIV-1 pol fragment was amplified and sequenced.For HIV subtyping,phylogenetic tree was constructed using MEGA 5.02 software.Drug-resistant mutations were determined using the Stanford University HIV Drug Resistance Database.Molecular transmission network was analyzed using HyPhy 2.2.1 and Cytoscape 3.2.1 software.Results A total of 817 sequences were obtained.The most common subtype was CRF07_BC,accounting for 99.1％(810/817)of the HIV strains,and the rate of drug resistant was 58.5％(478/817).The rates of HIV drug resistance to nonnucleoside reverse transcriptase inhibitor(NNRTI),nucleoside reverse transcriptase inhibitor(NRTI),and protease inhibitor(PI)were 53.0％(433/817),18.8％(154/817),7.8％(64/817)respectively.Multivariate logistic regression showed that compared with a baseline CD4+T lymphocyte count of less than 350 cell/μL,CD4+T lymphocyte count between 350～499 cell/μL was 0.61 times(95％CI:0.41-0.91)likely to have drug resistance.Patients receiving Lopinavir/Ritonavir(LPV/r)-based initial regimens was 0.27 times(95％CI:0.12-0.61)likely to have drug resistance as compared with those with TDF based regimens.In addition,patients receiving ART between 2018 and 2020 was 0.62 times(95％CI:0.44～0.87)to get drug resistance compared with those receiving ART before 2018.There were 49.1％(401/817)of the HIV strains within molecular network based on 1.5％of gene distance threshold,and 26 clusters were found.The clusters which had drug resistance sequence were 96.2％(25/26).The molecular network access rate in male was higher than female.The rate of drug resistant was relatively high among people living with HIV/AIDS who had virological failure after ART in this area,and drug resistant sequences were transmitted as shown in clusters.The intervention and surveillance among these individuals should be strengthened,to decrease the risk of drug resistance and transmission.
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