Emergence of HIV-1 Drug Resistance Mutations Among Children and Adolescents Undergoing Prolonged Antiretroviral Therapy in Guangxi

Objective Antiretroviral therapy (ART) has been implemented in Guangxi for a long time, and no reports about HIV drug resistance mutation (DRM) among children and adolescents experiencing virological failure after ART. This study aimed to analyze HIV DRM prevalence, patterns, and influencing factors among children and adolescents experiencing virologic failure after ART in Guangxi. Methods We collected samples from a total of 491 HIV-infected individuals under 18 years old experiencing virological failure after ART from 14 cities in Guangxi. Sequencing and DRM analysis were performed based on pol region. Multivariate logistic regression was employed to analysis the influencing factors of DRM. Results Among these patients, 396 cases were successfully sequenced. Of all, 52.53% exhibited HIV DRM, including NNRTI (48.48%), NRTI (34.85%) and PI (1.01%). NRTI and NNRTI dual-class resistance was prevalent (30.3%). M184V/I and K103N mutations were the common mutations in NRTI and NNRTI respectively. Men gender (aOR=2.1, 95%CI: 1.26-3.50), CRF01_AE subtype (OR=2.50, 95%CI: 1.02-5.88), the primary regimen 3TC+AZT+NVP (OR=10.00, 95%CI: 5.00-25.00), low pre-treatment CD4+ T lymphocytes (<200 cells/mm³) (OR=1.85, 95%CI: 1.00-3.45), and high viral load (> 1000 copies/ml) (OR=4.90, 95%CI: 1.03-23.39) shown higher risk of DRM. Conclusion HIV DRM is pervasive among children and adolescents experiencing virologic failure in Guangxi. Timely HIV DRM monitoring is crucial to mitigate major mutation accumulation and inform effective treatment strategies.