Transmitted HIV Drug Resistance Among Individuals With Newly Diagnosed HIV Infection

A Multicenter Observational Study

Jingrong Ye; Mingqiang Hao; Hui Xing; Fujie Zhang; Hao Wu; Wei Lv; Tianjun Jiang; Yuncong Wang; Juan Wang; Yi Feng; Ruolei Xin; Ji Zeng; Shuai Zhao; Yinxiao Hao; Jing Chen; Yuhua Ruan; Xue Li; Yiming Shao; Hongyan Lu


AIDS. 2020;34(4):609-619. 

In This Article

Abstract and Introduction


Objectives: Fifteen years after the roll-out of antiretroviral treatment (ART) in China, there is limited information available on transmitted HIV drug resistance (TDR). This study aimed to characterize the epidemiology of TDR in China.

Design: We conducted a prospective cross-sectional observational study.

Methods: We analyzed the demographic, clinical, and virological data of individuals with newly diagnosed HIV infection using data from the Beijing HIV laboratory network collected between 2001 and 2017. We did population-based sequencing of the pol gene on plasma specimens and identified TDR mutations using the WHO list for surveillance of TDR mutations.

Results: Data on TDR were available for 91% of the 10 115 individuals with newly diagnosed HIV infection tested, of whom 19.2% were from rural areas. The overall prevalence of TDR was 4.1% [95% confidence interval (CI): 3.7–4.5%], with a declining trend over the period 2001–2017. In the multivariable analysis, the risk of TDR differed significantly according to sex [odds ratio (OR) for women vs. men: 0.41, 95% CI: 0.22–0.69, P = 0.002]; infection type (OR for CRF07_BC vs. CRF01_AE: 0.24, 95% CI: 0.16–0.36, P < 0.001); and sampling period (OR for 2009–2012 vs. 2001–2008: 0.57, 95% CI: 0.41–0.79; P = 0.01), and was significantly higher among individuals from Hebei province than in those from Beijing (OR: 1.43, 95% CI: 1.05–1.96; P = 0.02).

Conclusion: In China, the prevalence of TDR among individuals with newly diagnosed HIV infection is relatively low. Trends in TDR should be assessed in other countries with a high TDR burden.


China has a slowly increasing HIV epidemic, with 758 610 individuals living with HIV at the end of 2017, of whom 80.4% were being treated through the China National Free Antiretroviral Treatment Program (NFATP).[1] The NFATP had markedly improved the prognosis of individuals with HIV.[2] However, there has long been a concern that transmitted HIV drug resistance (TDR) has increased in parallel with the increasing availability of antiretroviral treatment (ART), which can compromise the effectiveness of first-line ART regimens.[3] This concern is particularly important as China implemented the WHO 'treat-all', 'treat-early', and 'treatment as prevention' policy in 2016.[4,5] Growing TDR constitutes a threat to attaining the 90–90–90 targets set by the Joint United Nations Program on HIV/AIDS (UNAIDS), particularly the third 90 (90% of all people taking ART having a suppressed viral load), and the goal of elimination of HIV infection as a public health threat by 2030.[6,7] Previous studies have shown a wide range (2.1–15.0%) in the prevalence of TDR in China, which has differed according to the study population, time period, and definition of TDR.[8–17] Most previous studies were limited to MSM and were conducted in urban areas.[13–17] None of the previous studies have assessed the level of TDR in other risk groups, such as injection drug users (IDU), former blood donors, and individuals living in rural areas, or assessed the overall longitudinal trends in prevalence and patterns of TDR. Continued monitoring in a specific population can provide important insights into the trends of TDR that may inform clinical practice by indicating which first-line ART regimens should be used and whether baseline TDR testing should be performed.[18] In this study, we aimed to characterize the epidemiology of TDR from 2001 to 2017 in China.