| ObjectiveThis study aimed to describe the prevalence of HIV-1 genotypes and pretreatment HIV-1 drug resistance(PDR)in newly diagnosed HIV/AIDS patients in Tianjin,China.Thereby it could provide scientific evidences in the selection of optimal antiretroviral treatment(ART).MethodNewly diagnosed HIV/AIDS individuals visiting the Red Ribbon Clinic of Tianjin Second People’s Hospital from September 2018 to June 2019 were enrolled.Basic information such as gender,age,marital status and transmission route were collected through a questionnaire.Patients’venous blood was collected for lymphocyte count,HIV viral load test and HIV genotypic drug resistance test.HIV resistance analysis was conducted via the Stanford University HIVdb algorithm(http://HIVdb.stanford.edu).Patients were divided into PDR group and non-PDR group,and the differences in basic indicators between the two groups were compared.We explored the distribution of HIV-1 genotypes through phylogenetic analysis,the relationship between transmission routes and HIV-1 genotypes was analyzed.The relationship between PDR and HIV-1genotypes was also investigated.Result1.A total of 322 people living with HIV-1 were analyzed.They were divided into non-PDR group(287)and PDR group(35).There were no significant differences in general demographic indicators between the two groups(all P>0.05).2.Most of the cases were infected through homosexual behavior(63.0%),followed by heterosexual transmission(23.9%).There was no significant difference in terms of transmission routes between the two groups(P=0.422).3.The proportion of PDR patients with CD4~+count<200 cells/mm~3 was significantly higher than those without PDR(54.3%vs 35.2%,P=0.027).The CD8~+count in the non-PDR group was significantly higher compared to PDR group(P=0.044).No significant difference was found in the CD4/CD8 ratio HIV-1 viral load and between PDR and non-PDR groups(all P>0.05).4.CRF01＿AE(65.2%)was the predominant subtype among HIV/AIDS patients in Tianjin,followed by CRF07＿BC(22.7%)and B(2.8%).A lot of circulation recombination forms(CRFs)and unique recombination forms(URFs)were found as well.All subtypes mentioned above were mainly infected by homosexual transmission,followed by heterosexual transmission(P=0.684).5.The incidence of PDR was significantly lower in CRF01＿AE and CRF07＿BC compared to the other subtypes(all P>0.05).6.The total incidence of PDR in Tianjin was 10.9%,of which the incidence of non-nucleoside reverse-transcriptase inhibitors(NNRTIs)was 9.3%,nucleoside reverse-transcriptase inhibitors(NRTIs)2.2%and protease inhibitors(PIs)0.3%.Most of these resistant strains only harbored on drug resistant mutation(DRM),caused a reduction in the sensitivity of one antiretroviral(ARV)drug class.7.The proportion of patients who developed at least low-level of resistance to NNRTIs was estimated at 2.5%,which was significantly higher than others(P=0.030).There was no significant difference in drug-resistant rates between each drug class(all P>0.05).Conclusion1.In Tianjin,homosexual behavior was the main transmission route.Men who have sex with man(MSM)had become the main source of recombinant strains.The incidence of PDR in CRF01＿AE and CRF07＿BC were lower than that in other subtypes.2.Patients with PDR displayed lower CD4~+and CD8~+count than those without.3.This study demonstrated that PDR level in Tianjin was relatively high.Thus,drug resistance test should be routinely conducted before initiating ART.4.There existed strains highly resisting against commonly used first-line ARV drugs in Tianjin,with the potential-low level of resistance related to NNRTIs were relatively high.Patients should be closely monitored for clinical manifestations,viral load,CD4~+and CD8~+counts during ART.If necessary,repeating drug resistance test should be done to avoid virologic failure. |
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