title: Population-based human immunodeficiency virus 1 drug resistance profiles among individuals who experienced virological failure to first-line antiretroviral therapy in Henan, China during 2010-2011.
abstract: BACKGROUND
  In Henan, China, first-line antiretroviral treatment (ART) was implemented early in a large number of treatment-experienced patients who were more likely to have a drug resistance. Therefore, we investigated the human immunodeficiency virus (HIV)-1 drug resistance profiles among patients in Henan who experienced virological failure to ART.
  
  
  METHODS
  A cross-sectional survey was administered in 10 major epidemic cities from May 2010 to October 2011. Adult patients who experienced virological failure (virus load ≥1,000 copies/mL) with >1 year of first-line antiretroviral treatment consented to provide blood for genotype resistance testing. The clinical and demographic data were obtained from the patients' medical records. Logistic regression analysis was performed to determine the factors associated with ≥1 significant drug resistance mutation.
  
  
  RESULTS
  We included 3,235 patients with integral information and valid genotypic resistance data. The city, age, CD4 counts, virus load, treatment duration, and World Health Organization stage were associated with drug resistance, and 64.76% of patients acquired drug resistance. The nucleoside reverse transcriptase inhibitor (NRTI), non-(N)NRTI, and protease inhibitor resistance mutations were found in 50.26, 63.12, and 1.30% of subjects, respectively. Thymidine analogue mutations, NNRTI and even multidrug resistance complex were quite common in this patient cohort.
  
  
  CONCLUSIONS
  Multiple and complex patterns of HIV-1 drug resistance mutations were identified among individuals who experienced virological failure to first-line ART in Henan, China during 2010-2011. Therefore, timely virological monitoring, therapy adjustments, and more varieties of drugs and individualized treatment should be immediately considered in this patient population.
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, Henan China.
authors.forename: Jia
authors.initials: J
authors.lastname: Liu
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Yasong
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, Henan China.
authors.forename: Wenjie
authors.initials: W
authors.lastname: Yang
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, Henan China.
authors.forename: Xiujuan
authors.initials: X
authors.lastname: Xue
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, Henan China.
authors.forename: Guoqing
authors.initials: G
authors.lastname: Sun
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, Henan China.
authors.forename: Chunhua
authors.initials: C
authors.lastname: Liu
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, Henan China.
authors.forename: Suian
authors.initials: S
authors.lastname: Tian
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, Henan China.
authors.forename: Dingyong
authors.initials: D
authors.lastname: Sun
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, Henan China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhu
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, Henan China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Wang
keywords: Drug resistance; First-line antiretroviral therapy; HIV; Virological failure