Evolving HIV-1 epidemiology, drug resistance and socio-demographics among blood donors in Dalian, Northeastern China, 2011-2024.

BACKGROUND AND

OBJECTIVES

Human immunodeficiency virus type 1 (HIV-1) prevalence among Chinese blood donors has risen over recent decades, showing marked regional variation. Yet molecular epidemiology data among Chinese donors remain limited.

MATERIALS AND

METHODS

From 2011 to 2024, blood donations in Dalian, Liaoning Province, were screened using HIV antibody and antigen tests combined with multiplex nucleic acid testing. HIV-1 infection rates, molecular characteristics, genetic diversity, drug resistance and donor socio-demographics were analysed. Partial HIV-1 pol sequences were evaluated for drug resistance mutations (DRMs) using the Stanford HIV Drug Resistance Database algorithm.

RESULTS

The HIV-1 infection rate peaked at 55.3 per 100,000 donations in 2013 and stabilized at 12-21 per 100,000 in recent years. Most infected donors were young, male, single and first-time donors. Sexual transmission predominated, particularly among men who have sex with men (MSM) (49.8%), of whom 33.8% were repeat donors. Genetic analysis revealed substantial subtype diversity, dominated by CRF01_AE and CRF07_BC, with unique recombinant forms and occasional non-Asian subtypes. Molecular clustering suggested possible test-seeking behaviour. Notably, 6.8% of HIV-positive samples harboured DRMs, mainly against non-nucleoside reverse transcriptase inhibitors, indicating sporadic transmission of resistant strains.

CONCLUSION

These findings underscore the need for strengthened pre-donation education and sustained HIV molecular surveillance to protect blood safety and inform public health strategies.