Comparison of clinical characteristics in acute and early HIV-1 infection across different subtypes: a hospital-based cohort study.

BACKGROUND

Early diagnosis and immediate antiretroviral therapy (ART) for acute and early HIV-1 infection (AEHI) effectively curb HIV transmission and restrict viral reservoir formation. However, subtype-specific transmitted drug resistance (TDR) and early ART virological response remain insufficiently characterized among circulating HIV-1 recombinants in the Guangdong-Hong Kong-Macao Greater Bay Area. This study aimed to compare these key indicators across different HIV-1 subtypes.

METHODS

This hospital-based cohort study enrolled 105 AEHI patients from 2019 to 2024. HIV-1 pol gene sequencing was performed for subtype classification and drug resistance genotyping. Antiretroviral therapy responses were monitored at weeks 4, 12, 24, and 48. Demographic, clinical, virological, immunological, and TDR data were systematically analyzed across all HIV-1 subtypes.

RESULTS

CRF07_BC was the dominant strain (32.4%), followed by other BC recombinants (30.5%) and CRF01_AE (22.9%). Poppers use was significantly associated with CRF07_BC transmission among MSM (P = 0.007). The B+CRF01_AE/CRF55_01B group exhibited an extremely high TDR rate of 90.9% (P < 0.001), dominated by V179E and M184V mutations. At weeks 12 and 24 post-ART, BC recombinants and B+CRF01_AE/CRF55_01B showed slower viral suppression than CRF07_BC, while all subtypes achieved comparable long-term immune recovery (92.6% virological suppression at week 48).

CONCLUSION

Significant heterogeneity in TDR and early viral load suppression exists among HIV-1 subtypes during acute infection. Baseline drug resistance testing and intensified viral load monitoring are recommended for patients with B/CRF01_AE recombinant strains. These findings support regional HIV molecular surveillance and subtype-targeted early intervention.