The Journal of antimicrobial chemotherapy · 2026
Effect of pretreatment HIV drug resistance on mortality, attrition and viral suppression in patients initiating antiretroviral therapy and genetic transmission network: an observational cohort study in Southwest China.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Qin Litai, Xie Yihong, Li Jianjun, Zhong Ge, Chen Jin, Zhu Qiuying, Liang Shujia, Xing Hui, Liao Lingjie, Feng Yi, Shao Yiming, Ruan Yuhua, Lan Guanghua, Chen Huanhuan
Аннотация
OBJECTIVES: Pretreatment drug resistance (PDR) compromises antiretroviral therapy (ART) efficacy and is a major concern in HIV care, yet its consequences for key treatment outcomes are not well-defined. We therefore systematically investigated the prevalence of PDR and its impact on mortality, attrition and viral suppression amongst patients starting ART.
METHODS: An observational cohort study was conducted in Southwest China, 2014-2022. PDR was analysed using the Stanford HIV Drug Resistance Database. Molecular transmission networks were constructed with HIV-TRACE. Cox and logistic regression evaluated the impact of PDR.
RESULTS: Amongst 3478 eligible patients, the overall prevalence of PDR was 6.4%. PDR rates to non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors and protease inhibitors were 4.1%, 1.3% and 1.1%, respectively. The overall mortality and attrition rates were 4.58 and 2.40 per 100 person-years, respectively. Whilst PDR showed no significant association with mortality, it was associated with increased attrition. Compared to those without resistance, the adjusted HR (95% CI) for attrition was 1.67 (1.11-2.52) in the overall drug-resistant group, 2.16 (1.36-3.43) in the NNRTI-resistant group and 2.09 (1.10-3.97) in the efavirenz/nevirapine-resistant group. Viral suppression was significantly lower in the drug-resistant group [adjusted odds ratio (AOR): 0.46; 95% CI: 0.27-0.77], the NNRTI-resistant group (AOR: 0.42; 95% CI: 0.22-0.78) and the efavirenz/nevirapine-resistant group (AOR: 0.41; 95% CI: 0.21-0.81).
CONCLUSIONS: Our study reveals a moderate prevalence of PDR in Southwest China, significantly associated with increased risk of attrition and virologic failure, particularly amongst patients with resistance to efavirenz/nevirapine. Our findings strongly advocate for routine PDR testing prior to ART initiation to guide optimal first-line treatment strategies.
METHODS: An observational cohort study was conducted in Southwest China, 2014-2022. PDR was analysed using the Stanford HIV Drug Resistance Database. Molecular transmission networks were constructed with HIV-TRACE. Cox and logistic regression evaluated the impact of PDR.
RESULTS: Amongst 3478 eligible patients, the overall prevalence of PDR was 6.4%. PDR rates to non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors and protease inhibitors were 4.1%, 1.3% and 1.1%, respectively. The overall mortality and attrition rates were 4.58 and 2.40 per 100 person-years, respectively. Whilst PDR showed no significant association with mortality, it was associated with increased attrition. Compared to those without resistance, the adjusted HR (95% CI) for attrition was 1.67 (1.11-2.52) in the overall drug-resistant group, 2.16 (1.36-3.43) in the NNRTI-resistant group and 2.09 (1.10-3.97) in the efavirenz/nevirapine-resistant group. Viral suppression was significantly lower in the drug-resistant group [adjusted odds ratio (AOR): 0.46; 95% CI: 0.27-0.77], the NNRTI-resistant group (AOR: 0.42; 95% CI: 0.22-0.78) and the efavirenz/nevirapine-resistant group (AOR: 0.41; 95% CI: 0.21-0.81).
CONCLUSIONS: Our study reveals a moderate prevalence of PDR in Southwest China, significantly associated with increased risk of attrition and virologic failure, particularly amongst patients with resistance to efavirenz/nevirapine. Our findings strongly advocate for routine PDR testing prior to ART initiation to guide optimal first-line treatment strategies.