Transmitted HIV-1 Drug Resistance Exceeds 10% in China, Impacts Antiretroviral Therapy Efficacy

Strategic Insights -

Research conducted across 31 provincial-level administrative divisions in China between April and June 2023 has found that transmitted drug resistance (TDR) among individuals newly diagnosed with HIV-1 in China exceeds 10%. The study analyzed demographic information and blood samples from 6,654 participants and found that TDR prevalence was 11.4% (95% confidence interval [CI], 10.6%-12.2%). Resistance to nonnucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs) was observed at 7.9%, 0.8%, 2.4%, and 1.0%, respectively. The study highlights the necessity for continuous monitoring and timely adjustment of antiretroviral therapy (ART) regimens to mitigate the impact of drug resistance on treatment efficacy.

Key Takeaways:

  • The study found that transmitted drug resistance (TDR) among newly diagnosed individuals with HIV-1 in China exceeds 10%, with a prevalence of 11.4% (95% CI, 10.6%-12.2%).
  • Resistance to NNRTIs, NRTIs, PIs, and INSTIs was observed at 7.9%, 0.8%, 2.4%, and 1.0%, respectively.
  • The study linked TDR to non-Han ethnicity, unknown transmission routes, and CD4 count ≤ 500 cells/mL, while higher education (high school or more) reduced TDR odds.
  • Timely monitoring of TDR and adjustment of ART regimens are essential to mitigate the impact of drug resistance on treatment efficacy.
  • The study emphasizes the importance of continuous monitoring and surveillance to track TDR and monitor its impact on public health.

Statistics:

  • 11.4% (95% CI, 10.6%-12.2%) of participants showed transmitted drug resistance (TDR) to HIV-1.
  • 7.9% of participants were resistant to NNRTIs.
  • 0.8% of participants were resistant to NRTIs.
  • 2.4% of participants were resistant to PIs.
  • 1.0% of participants were resistant to INSTIs.
  • 6.5% of participants were resistant to efavirenz/nevirapine (EFV/NVP).

Sources:

  • Transmitted HIV-1 Drug Resistance Among Newly Diagnosed Individuals in 31 Provincial-Level Administrative Divisions in China in 2023: A Cross-sectional Survey. Clinical Infectious Diseases, 2025;81(3):531-538.
  • AIDS Weekly. October 20, 2025; p 279.