Drug resistance among AIDS population with failed antiviral therapies in Aksu area and molecular network analysis

OBJECTIVE To understand the drug resistance among the acquired immune deficiency syndrome (AIDS) population who failed in the antiviral therapy from 2022 to 2023 and analyze the molecular network.

METHODS The plasma specimens were collected from the population with viral load no less than 1000 cps/ml who received antiviral therapy for more than 6 months in Aksu area from 2022 to 2023, which were delivered to Aksu Regional Center for Disease Control and Prevention for test. MEGA5 and the Stanford University drug resistance database were employed to determine the subtypes and drug resistance after the sequences of human immunodeficiency virus type Ⅰ polymerase gene region (HIV-1pol) were obtained, and the molecular network was established by HIV-trace.

RESULTS Totally 648 sequences of HIV-1pol region were obtained, CRF07_BC (97.69%) was the major subtype, and the drug resistance rate was 58.33%; the drug resistance rates to non-nucleoside reverse transcriptase inhibitor (NNRTI), nucleoside reverse transcriptase inhibitor (NRTI) and protease inhibitor (PI) were 51.70%, 19.75% and 8.64%, respectively. The univariate analysis showed that year (χ²=6.341), age (χ²=18.455) and route of infection (χ²=14.061) had remarkable effects on the drug resistance among the population with failed ART(P < 0.05). Multivariate regression analysis indicated that the drug resistance rate was higher in 2022 than in 2023 (95%CI: 1.132 to2.191), and the drug resistance rate was higher among the population aged less than 60 years old than among the population more than 6 years old (95%CI: 3.647 to 70.268, 95%CI: 1.435 to 8.235, 95%CI: 1.061 to 6.164, respectively). With 1.5% of the genetic distance set as the threshold, the molecular network was established, the network access rate was 49.07%, 77.14% of the clusters had drug-resistant mutation sites, and the male population was at higher risk of network access than the female population.

CONCLUSIONS The drug resistance rate is relatively high among the AIDS population with failed ART, and the drug-resistant strains appear in clusters in the molecular network. It is necessary to further strengthen the monitoring of drug resistance and improve the quality of the follow-up so as to reduce the occurrence of drug resistance and transmission of virulent strains.