Treatment failure and drug resistance among the newly reported HIV-infected patients in Taizhou City from 2020 to 2022
10.19428/j.cnki.sjpm.2024.23877
- VernacularTitle:台州市2020—2022年新报告HIV感染者治疗失败及耐药情况分析
- Author:
Yan LI
1
;
Xuanhe WU
2
;
Lu SHI
3
;
Guixia LI
3
;
Shanling WANG
3
;
Yating WANG
3
;
Tailin CHEN
2
;
Tingting WANG
3
;
Yali XIE
3
;
Weiwei SHEN
3
;
Haijiang LIN
3
;
Xiaoxiao CHEN
3
;
Na HE
2
Author Information
1. Huangyan District Center for Disease Control and Prevention, Taizhou, Zhejiang318020, China
2. Department of Epidemiology, School of Public Health, Fudan University, Yiwu Research Institute of Fudan University, Shanghai200032, China
3. Taizhou Center for Disease Control and Prevention, Taizhou, Zhejiang318000, China
- Publication Type:Journal Article
- Keywords:
HIV;
recent infection;
antiretroviral therapy failure;
antiretroviral therapy strategy;
genotypic drug resistance
- From:
Shanghai Journal of Preventive Medicine
2024;36(11):1031-1038
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveTo analyze the failure of antiretroviral therapy (ART) and drug resistance characteristics among the newly reported HIV-infected patients in Taizhou City from 2020 to 2022. MethodsBlood samples, sociodemographic characteristics and ART information of the newly reported HIV-infected patients who received ART for ≥6 months in Taizhou City from 2020 to 2022 were collected for the detection of recent infections and HIV-1 genotypic drug resistance. Multivariate logistic regression analysis was used to analyze the influencing factors of treatment failure. The gene sequences of cases with failed ART were submitted to the HIV drug resistance database of Stanford University to determine the drug resistance mutation sites and drug resistance characteristics. ResultsAmong the 1 023 newly reported HIV-infected patients receiving ART, the median age （P25，P75） was 47 (33, 58) years, 81.4% were male, 66.4% (679/1 023) were infected through heterosexual transmission, 74.7% had a WHO clinical stage Ⅰ/Ⅱ, 62.2% had a baseline CD4 count of >200 cell·μL-1, 94.4% (966/1 023) received an immediate ART, and 78.7% were long-term infected. Among the 66 patients with treatment failure (6.5%), the likelihood of treatment failure was lower in those with homosexual transmission (OR=0.39, 95%CI: 0.17‒0.84) and without history of sexually transmitted disease (STD) (OR=0.45, 95%CI: 0.24‒0.92), but higher in those with a baseline CD4 count of ≤200 cell·μL-1, delayed ART (OR=3.19, 95%CI: 1.24‒7.52), and primary drug resistance (OR=4.69, 95%CI: 1.68‒11.89). Among the 36 HIV-infected patients with virological failure, 27 sequences were successfully amplified, with a successful amplification rate of 75.0% (27/36). The total drug resistance rate was 55.6% (15/27), of which the drug resistance rates of nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were 37.0% (10/27), 51.9% (14/27) and 3.7% (1/27), respectively. Among the NNRTIs, the degree of resistance to efavirenz and nevirapine was consistent, with a majority (51.9%) of highly drug-resistant. K103N and M184V were the most common mutation sites, but PIs mutations occured less frequently. A total of 8 genotypes of HIV-1 were detected, in which subtype CRF01_AE accounted for 37.0% (10/27), followed by CRF07_BC [14.8% (4/27)], CRF08_BC [14.8% (4/27)] and subtype C [14.8% (4/27)]. ConclusionDuring the period from 2020 to 2022, the newly reported HIV-infected individuals in Taizhou City were predominated by long-term infections. Immediate initiation of ART can reduce the risk of treatment failure in HIV-infected individuals. Virological treatment failures are primarily associated with resistance to NRTIs and NNRTIs. It is recommended to strengthen active detection and promptly initiate ART to minimize the occurrence of ART failure. Simultaneously, there is a need to intensify drug resistance detection targeted for those with treatment failure, so as to provide a scientific guidance for drug replacement.
