[Drug resistance characteristics of rilpivirine in HIV-1-infected patients before starting antiretroviral therapy in nine provinces of China].

Objective

To understand the drug resistance characteristics of rilpivirine (RPV) in HIV-1-infected patients before starting antiretroviral therapy (ART) in nine provinces of China.

Methods

A cross-sectional study design was adopted by probability proportional to size(PPS) sampling. Nine provinces (Hebei, Jilin, Jiangsu, Zhejiang, Hubei, Chongqing, Sichuan, Yunnan and Xinjiang) were selected as the research sites. A total of 148 sites of ART outpatient clinics were selected by PPS sampling. The research subjects were HIV-1-infected patients aged ≥18 years before starting ART from January to June 2022. Field investigations and detection of genotype resistance indicators were conducted on the research subjects. Statistical analysis was performed using SAS 9.4 software, and unconditional logistic regression was applied to analyze the related factors of RPV resistance in HIV-1-infected patients before ART.

Results

A total of 3 165 HIV-1-infected patients were investigated and sampled, and 2 821 subjects were included in the study. The resistance rate of non-nucleoside reverse transcriptase inhibitors (NNRTI) was 10.1% (284/2 821), and the resistance rate of RPV was 5.7% (160/2 821). Among HIV-1-infected patients with a history of antiretroviral drug exposure, the RPV resistance rate was 17.0% (16/94), and the proportions of high-resistance, moderate-resistance, and low-resistance grades of RPV were 7/16, 2/16, and 7/16, respectively. Among HIV-1-infected patients without prior antiretroviral drug exposure, the RPV resistance rate was 5.3% (144/2 727), and the proportions of high-resistance, moderate-resistance, and low- resistance grades of RPV were 9.03% (13/144), 8.33% (12/144), and 82.64% (119/144), respectively. There were statistically significant differences in the RPV resistance rate and the distribution of RPV resistance grades between the two groups (χ2=16.94, P=0.001). The cross-resistance rate between RPV and efaviren/nevirapine (EFV/NVP) in total HIV-1-infected patients before ART was 57.5% (92/160), which was significantly higher than that between RPV and doravirine (DOR) (25.0%, 40/160) and that between RPV and etravirine (ETR) (34.4%, 55/160) (all P<0.001). The results of the multivariate logistic regression model analysis showed that the positive related factors of RPV resistance before ART in HIV-1-infected patients included other ethnic groups (aOR=1.86, 95%CI: 1.29-2.68) and with a history of antiretroviral drug exposure (aOR=2.57, 95%CI: 1.41-4.67), CRF08_BC (aOR=4.02, 95%CI: 2.46-6.55), CRF55_01B (aOR=3.81, 95%CI: 1.93-7.52) and B (aOR=3.21,95%CI:1.40-7.37).

Conclusions

The resistance rates of HIV-1-infected patients to NNRTI and RPV before ART were at a medium level in nine provinces of China, and there was a high cross-resistance between RPV and EFV/NVP. The RPV resistance rate of HIV-1-infected patients with a history of antiretroviral drug exposure was relatively higher. It is recommended to conduct HIV-1 resistance testing for them before starting ART and formulate individualized treatment plans.