Influencing factors of genotypic drug resistance in people living with human immunodeficiency virus/acquired immunodeficiency syndrome who failed anti-retroviral therapy in Henan Province from 2018 to 2022
Objective To analyze the influencing factors of genotypic drug resistance mutations in people living with human immunodeficiency virus and acquired immunodeficiency syndrome(PLWHA)who failed anti-retroviral therapy(ART)in Henan Province,in order to provide a basis for adjusting ART regimens and reducing drug resistance.Methods PLWHA with virological failure(human immunodeficiency virus(HIV)RNA ≥500 copies/mL)after receiving ART for more than 24 weeks were included in Henan Province from January 2018 to December 2022.Baseline CD4+T lymphocyte counts,ART regimens and other clinical data were collected.HIV-1 gene subtypes and their drug resistance sequence mutations were detected in the Sixth People's Hospital of Zhengzhou,and the sequences were submitted to the HIV Drug Resistance Interpretation System of Stanford University for comparison of test results.Genotypic drug resistance to nucleotide reverse transcriptase inhibitors(NRTI),non-nucleoside reverse transcriptase inhibitors(NNRTI),protease inhibitors(PI)and integrase inhibitors(INSTI)was determined.Multivariate logistic regression was used to analyze the influencing factors of drug resistance in patients with ART failure.Results Among 982 PLWHA,the sequences of 899 cases were successfully amplified,and drug resistance was detected in 737 cases,with the drug resistance rate of 81.98％(737/899).The rates of resistance to NRTIs,NNRTIs,PIs and INSTIs were 71.97％(647/899),79.31％(713/899),5.23％(47/899)and 2.72％(20/734),respectively.The largest number of those who developed concomitant resistance to two classes of drugs was 588 cases(79.78％),mainly NRTI and NNRTI concomitant resistance in 583 cases(79.10％).There were 99 cases(13.43％)who developed resistance to only one class of drugs,and those who developed concurrent resistance to three classes of drugs were 48 cases(6.51％),and two cases(0.27％)were found to be resistant to all four classes of drugs mentioned above.A total of 10 HIV genotypes were detected,among which subtype B accounted for the most(59.73％(537/899)),followed by circulating recombinant form(CRF)01_AE subtype(21.91％(197/899))and CRF07_BC subtype(9.45％(85/899)).The risk factors affecting the development of drug resistance were baseline CD4+T lymphocyte counts,ART regimens and HIV-1 genotypes.The risk of drug resistance in patients with baseline CD4+T lymphocyte counts＜100/μL was 4.55 times(95％confidence interval(CI)2.69 to 7.70)higher than patients with CD4+T lymphocyte counts≥250/μL,the risk of drug resistance in patients using 2NRTIs+NNRTI regimen was 4.51 times(95％CI 1.75 to 11.63)higer than those using 2NRTIs+INSTI regimen,and patients infected with B and CRF01_AE subtype was 2.18 times(95％CI 1.10 to 4.29)and 2.70 times(95％CI 1.26 to 5.78)higer than those with CRF07_BC subtype,respectively.Conclusions The incidence of genotypic drug resistance in PLWHA with ART failure in Henan Province is high.Low baseline CD4+T lymphocyte counts,2NRTIs+NNRTI regimens,and genotype B and CRF01_AE are risk factors for drug resistance in PLWHA.
HIV infectionsAcquired immunodeficiency syndromeAntiretroviral therapyGenotypic drug resistanceInfluencing factors
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