2022 Yunnan survey links pretreatment HIV resistance to viral genotype

A 2022 survey of people in Yunnan Province, China, who were initiating or re-initiating antiretroviral treatment found that 11.4% of 377 successfully sequenced HIV-1 viruses carried drug-resistance mutations meeting World Health Organization criteria for pretreatment drug resistance to at least one of 12 drugs. Non-nucleoside reverse transcriptase inhibitor resistance-associated mutations were the most frequently detected, while the distribution of resistance mutations differed among the viral genotypes circulating in the province. The analysis, reported in BMC Infectious Diseases , was based on probability proportional to size sampling and characterized viral diversity and resistance present before participants’ current treatment course.

Researchers enrolled 399 individuals, extracted viral RNA and sequenced the pol gene region, obtaining 377 sequences for analysis. The viruses represented 17 HIV-1 genotypes, with CRF08_BC accounting for 48.0% of sequences, CRF07_BC for 21.8% and CRF01_AE for 12.7%. Multivariable analysis found associations between genotype and participant characteristics.

CRF08_BC was more prevalent among people aged 30 or older, with an adjusted odds ratio of 2.859. CRF01_AE was more prevalent among ethnic minorities, with an adjusted odds ratio of 2.395, and among participants with higher education levels, with an adjusted odds ratio of 5.606. These statistical associations do not establish that demographic characteristics caused infection with a particular genotype.

Resistance-associated mutations showed genotype-specific patterns. Mutations associated with nucleoside reverse transcriptase inhibitors, or NRTIs, occurred in 9.3% of the analyzed sequences and were most frequent among CRF01_AE viruses, at 16.7%. Within CRF01_AE, the S68G mutation was detected at a rate of 8.3%.

Mutations associated with non-nucleoside reverse transcriptase inhibitors, or NNRTIs, were found in 39.3% of sequences, with higher rates among CRF08_BC and less common genotypes. Protease inhibitor resistance-associated mutations were less frequent: primary mutations occurred in 1.9% of sequences and accessory mutations in 2.9%. Among CRF07_BC viruses, the accessory mutation Q58E was the most frequent, appearing in 6.1%.

Resistance to rilpivirine, a newer NNRTI, was detected in 16.2% of cases. The source data did not provide confidence intervals for these percentages in the reported abstract. Multivariable analysis identified a history of previous antiviral treatment as an independent risk factor for drug resistance, with an adjusted odds ratio of 6.675.

Infection with CRF08_BC was also an independent risk factor, with an adjusted odds ratio of 4.682. Because the population consisted of people beginning or restarting treatment, the study measured pretreatment resistance rather than the emergence or selection of resistance during the subsequent regimen. The results show that Yunnan’s HIV-1 population combined broad genetic diversity with a relatively high frequency of NNRTI resistance-associated mutations and genotype-specific patterns of mutation.

The authors concluded that a first-line regimen based on efavirenz or nevirapine may pose risks in this setting and called for enhanced resistance monitoring and optimization of treatment strategies, particularly for high-risk populations. The findings are limited by the observational survey design, the 2022 collection period and the focus on people entering or re-entering antiretroviral treatment. It was not a clinical trial, and no clinical trial number applied.

Subject of Research: HIV-1 genotype diversity and pretreatment antiretroviral drug resistance among people entering or restarting treatment in Yunnan, China

Article Title: HIV-1 genetic diversity and pretreatment resistance in Yunnan, a key endemic region of China

Article References: Jin, X., Chen, H., Dai, J., Dong, L., Jin, X., Yang, M., Sun, P., Zeng, Z., Ma, Y., Shi, Y., & Chen, M. (2026). HIV-1 genetic diversity and pretreatment resistance in Yunnan, a key endemic region of China. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14173-x

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14173-x

Keywords: HIV-1, pretreatment drug resistance, Yunnan, viral genetics, NNRTI resistance, antiretroviral therapy, CRF08_BC, CRF01_AE, genetic surveillance, genetic, diversity, pretreatment