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Abstract
HIV-1 drug resistance in China: nation-wide survey and analysis of impacting factors in the national ARV treatment program
Xing H.1, Jiang S.1, Si X.1, Cheng H.1, Shang H.2, Li J.3, Kang L.4, Zhong P.4, Shao Y.1
1National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China, 2China Medical University, Shenyang, China, 3Chinese Academy of Military Medical Sciences, Beijing, China, 4Shanghai Center for Disease Control and Prevention, Shanghai, China
Objective: To evaluate China’s ART program and provide HIV DR monitoring for the patients under HAART.
Methods: Random sampling is applied to HIV-1 infected subjects with and without ART treatment. The subjects’ epidemiological data were collected and blood tested for viral load, CD4 count, and HIV DR genotyping by sequencing. The sequencing data is analyzed and scored based on the Stanford HIV drug resistance database.
Results: In 2002, 2% medium and low resistance and no high resistance HIV DR related mutations were found in 200 HIV infected people from 20 provinces before ART program start. In 2004 study, very low background of 3.0% medium and low resistance and 1.2% high resistance HIV DR related mutations were found in 665 HIV positive drug naïve patients. Among patients in government treatment program using 4 regimens (average 8 month treatment), the best viral control rate of 95.3% (undetectable viral load) was achieved by AZT/3TC/NVP (N=41), followed by 70.8% by D4T/DDI/EFV (N=24), 65.5% by D4T/DDI/NVP (N=220) and 49.4% by AZT/DDI/NVP (N=81). HIV DR-related mutation was more frequently detected in individuals with using D4T/DDI/NVP and AZT/DDI/NVP (24.1% and 17.6% respectively) than in individuals using AZT/3TC/NVP and D4T/DDI/EFV (2.4% and 0.0% respectively). Logistic analysis showed the emerging DR-related mutation is positively correlated with the failure of viral control and the length of treatment. Emergence of multi-DR-related mutation was mainly found in ones adherent to one regimen and in subjects dropping out from ART therapy (19.2 % and 18.0% respectively).
Discussions: The frequency of HIV DR-related mutation is very low in drug naïve HIV-1 infected subjects in China. The regimens of AZT/3TC/NVP and D4T/DDI/EFV are better than AZT/DDI/NVP and D4T/DDI/NVP measured by viral control and inhibition of HIV DR-related mutations. The emergence of DR-related mutation was the cause of ART treatment failure.
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