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Outline
To analyze the drug resistance and molecular network characteristics of HIV/AIDS treatment failure patients in Urumqi City, and provide a theoretical basis for AIDS prevention and control.
A total of 1 281 patients who received antiviral treatment in AIDS antiviral designated medical institutions in Urumqi City from 2018 to 2023 and had a viral load (VL) ≥1 000 copies/mL were classified as treatment failure patients and included. The pol region gene of HIV-1 was amplified by nested PCR, and a phylogenetic tree was constructed using the neighbor-joining method. χ2 text and logistic regression were used to analyze the factors related to drug resistance, and a molecular network was constructed using 1.5%optimal gene distance. The drug resistance mutation sites were analyzed through the online tool HIV drug resistance database of Stanford University in the United States.
Five gene subtypes were identified in 1 281 sequences, with the dominant subtype being CRF07_BC (92.58%). The HIV-1 resistance rate was 55.27%, while the resistance rates to Nucleoside reverse transcriptase inhibitors (NRTIs), Non-nucleoside reverse transcriptase inhibitors (NNRTIs), and Protease inhibitors (PIs) were 25.53%, 48.40%, and 7.57%. The main resistance sites were K103 (29.98%), M184 (22.79%), and Q58 (5.31%). Multivariable logistic regression indicated lower risk of drug resistance among females (OR=0.686, 95% CI=0.538-0.873), those aged 25-49 years (OR=0.444, 95% CI=0.245-0.804), patients on AZT+3TC+NVP/EFV (OR=0.506, 95% CI=0.375-0.683), and those with baseline CD4+ T-cell counts of 200-349 (cells/μL) (OR=0.547, 95% CI=0.400-0.750). By constructing a molecular network, a total of 62 transmission clusters were identified, with 402 patients entering the network, resulting in a network entry rate of 31.38%. A total of 173 patients developed drug resistance, with a resistance rate of 43.03%. Male patients had a higher network entry rate than female patients,and genetic subtypes CRF07_BC, CRF01_AE, and CRF55_01B all appeared in clusters.
The drug resistance rate of HIV/AIDS treatment failure patients in Urumqi is relatively high, and drug-resistant strains appear in clusters in the molecular network. It is necessary to strengthen drug resistance monitoring and reduce the clustered transmission of drug-resistant strains.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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