ORIGINAL RESEARCH article
Front. Microbiol.
Sec. Virology
This article is part of the Research TopicThe Future of HIV Care: Innovative Treatment StrategiesView all 6 articles
HIV-1 drug resistance and genetic clustering among ART-treated individuals with virologic failure in Aksu, China
Provisionally accepted
- 1School of Medicine, Tarim University, Alar, China
- 2Aksu Prefecture Center for Disease Control and Prevention, Aksu 843000, China;, aksu, China
- 3College of Life Sciences and Technology, Tarim University, Alar,843300, China, Alar, China
- 4School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China, Xi’an, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background:Aksu Prefecture is among the regions most heavily affected by HIV-1 in China, yet data on acquired drug resistance (ADR) among antiretroviral therapy (ART)–treated individuals with virologic failure remain limited. This study aimed to characterize the prevalence, mutation patterns, and genetic clustering of drug resistance mutations (DRMs) in Aksu. Methods:We conducted a retrospective study among ART-treated individuals with virologic failure in Aksu Prefecture from 2022 to 2023. HIV-1 pol sequences were obtained from 675 individuals to identify DRMs. Genetic networks were constructed to assess clustering among individuals harboring DRMs (n=407). Univariable and multivariable logistic regression analyses were used to identify factors associated with DRMs clustering. Results:The prevalence of ADR was 56.9% (384/675). CRF07_BC was the predominant subtype (97.6%). The most common DRMs were K103N/S (60.7%), M184V/I (27.3%), G190A/E/S (11.3%), and E138A/K/Q/G (10.8%), conferring high-level resistance mainly to lamivudine (3TC), efavirenz (EFV), and nevirapine (NVP). K65R was more frequent among individuals receiving TDF+3TC+EFV/NVP, whereas Q58E was more common among those receiving LPV/r+3TC+TDF/AZT (both p < 0.05). Genetic network analysis showed that 34.2% (139/407) of individuals with DRMs formed clusters. Higher viral load was associated with clustering, whereas LPV/r-based regimens were associated with a lower likelihood of clustering. Conclusions: HIV-1 ADR remains highly prevalent among ART-treated individuals with virologic failure in Aksu. Extensive resistance to NNRTIs was observed, whereas susceptibility to LPV/r was largely preserved. The clustering of DRMs underscores the importance of molecular surveillance for guiding targeted interventions. These findings support accelerating access to effective second-line regimens, strengthening pretreatment resistance surveillance, and prioritizing adherence support among central individuals with high viral loads.
Keywords: Antiretroviral drug resistance, antiretroviral therapy, Cluster analysis, genetic network, HIV-1
Received: 03 May 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 Dai, LI, Xu, Feng, Sun, Lu and Bi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yuxue Bi
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.