Molecular transmission network and drug resistance in treatment-naïve HIV-1 infected patients in the Liangshan District, China

Objective This study aimed to investigate the molecular transmission network and drug resistance in treatment-naïve HIV-1 infected patients in the Liangshan District, China. Methods The research subjects for this study were HIV-1 infected patients who did not receive any anti-retroviral therapy (ART) in the Liangshan District between January 2022 and July 2023. Peripheral venous whole blood samples were collected from the research subjects. 2 mL blood was used for CD4+ T lymphocyte counting detection. 10 mL blood was centrifuged to separate the plasma and blood cells for quantitative detection of HIV-1 RNA and DNA and drug resistance testing of HIV-1. Results A total of 156 participants were included in this study (88 males and 68 females). The median age of the participants was 37 years old. The findings revealed a positive correlation between the HIV-1 DNA and the HIV-1 RNA levels (r=0.478, P<0.001). However, a negative correlation was observed between HIV-1 DNA levels and CD4+ T lymphocyte counts (r=-0.186, P=0.020). Of the 156 participants, 148 were successfully tested for drug resistance of HIV-1 RNA and HIV-1 DNA simultaneously. Four cases failed the HIV-1 RNA drug resistance testing, and another four failed the HIV-1 DNA drug resistance testing. The most common HIV-1 subtype was the CRF07_BC recombinant. In this study, the overall incidence of transmitted drug resistance (TDR) was 8.33%. The resistance rates of non-nucleoside reverse transcriptase inhibitor (NNRTI) and protease inhibitor (PI) were 7.69% and 0.64%, respectively. Additionally, 32 participants were found to have drug-resistant mutations. The primary drug-resistant mutations were K103N, V179D, E157Q, and A128T, mainly against efavirenz (EFV) and nevirapine (NVP) resistance. Conclusion The drug resistance of HIV-1 infected ART-naïve patients in the Liangshan District cannot be ignored. HIV-1 drug resistance testing is recommended before initiating ART.