Characterization Of HIV-1 Genotypes And Drug Resistance Among 4 Provinces In Northeast Of Vietnam

Objectives To characterize the HIV-1 genetic subtype and drug resistance among 4provinces in Northeast of Vietnam,to understand the HIV-1 subtype distribution and drug resistance epidemic in the China-Vietnam border area.Methods This study recruited 433 HIV infected individuals who received Highly Active Anti-Retroviral Therapy from the 4 provinces of Vietnam including Quang Ninh province,Lang Son province,Cao Bang province and Ha Giang province.All participants have been identified as HIV-1 infected individuals by West Blot test.For all include HIV-1 infected,we conducted epidemiological investigation,collected peripheral blood then extracted provirus DNA by amplified the gene fragments of HIV-1 pol(1.3 kb)by using reverse transcription/Nested-PCR.We performed sequence analysis of HIV-1 pol which encodes protease(PR)and reverse transcriptase(RT)in provirus by the software package Bioedit,Chromas,MEGA.At last,the statistics software SPSS 16.0 was used to identify the difference in subtype distribution and drug resistance among 4 provinces.Results1.As a result,we included 112 cases in Cao Bang province,121 cases in Ha Giang province,96 cases in Lang Son province,and 104 cases in Quang Ninh province,accounting for 25.87%,27.94%,22.17% and 24.02%,respectively.Of them were 247 male(51.2%),and male to female was 1.2:1.The average age was(38.52±8.18),and most of them were at the age of 25~50.The marital status was mainly in married,divorced/widowed and unmarried individuals,accounting for 61.66%,19.63% and 14.55%,respectively.Most of infected individuals were graduated from junior high school degree or above,accounting for 88.91%.There was 52.66% individuals infected HIV through drug injection,followed by heterosexual transmission(26.33%).2.We successfully amplified 206 HIV-1 pol genes from 433 infected individuals.The genotypes were sequenced and the phylogenetic analysis showed that all the genotype of 206 pol genes were CRF01_AE subtypes.3.The drug resistance showed that there were 32 samples at least potential resistant to one drug,in which there were 19 samples resistant to NRTIs and NNRTIs,with the total drug resistance rate was 15.53%(32/206).There were13(13.40%)cases infected by injection drug use,8(12.31%)cases infected by heterosexual transmission.4.The drug-resistance rate among different province was different.Lang Son and Quang Ninh,accounted for 23.08%,followed by the Ha Giang(16.39%),Cao Bang(5.97%).5.In this study,32 resistant strains were obtained.NNRTIs and NRTIs double resistant strains up to 19 cases,accounting for 59.38%;Followed by NNRTIs(8cases),NRTIs(3 cases)and PIs(2 cases),accounted for 25%,9.38% and 6.25%.6.In NNRTIs drug resistance,the major mutations were 181,190,230 and 179,in which the mutation sites were Y181 C,G190A,M230 I and V179 D,accounted for 19.40%,13.34%,13.43% and 10.45%,respectively.In the NRTIs drug resistance,the major mutations were M184V(14.29%),V75M(10.00%),T215F(10.00%),M41L(8.57%)and K65R(7.14%)respectively.For PIs drug resistance,the major mutation was G73S(55.56%),following by I84 V,K43T,L89 V and L90 M.7.The results showed that the differences in the drug resistance degree of different drugs of NNRTIs were statistically significant(P < 0.001).NNRTIs drug resistance was mainly moderately resistant and highly resistant,accounting for81.55%.The moderate drug resistance was mainly the ETR(26.19%)and RPV(38.10%),and the high drug resistance was the EFV(28.57%)and NVP(42.86%).The differences in the drug resistance degree of different drugs of NRTIs were statistically significant(P<0.001),approximately accounting for two thirds of the total.High drug resistance was mainly FTC(29.51%)and 3TC(29.51%),followed by DDI(13.11%),ABC(9.84%),D4T(9.84%),AZT(4.92%)and TDF(3.28%).The differences in the drug resistance degree of different drugs of PIs were not statistically significant(P>0.05).The influence analysis of the resistance factors,multivariate logistics regression analysis showed that samples from the Lang Son and Quang Ninh province are risk factors for the occurrence of resistant genotypes(P < 0.05)?Conclusions: The HIV infected in these 4 provinces still were CRF01_AE subtypes,and the rate of potential drug-resistant mutation occurrences was higher than other regions in Vietnam,which was possibly related to the transmition routes and drug adherence in these 4 provinces.