Analysis of HIV Drug Resistance Mutations Along With Treatment Outcomes of Efavirenz-Based Regimens in Patients With V179D/E Mutations in Guangzhou, China.

AIM: To analyze the prevalence of human immunodeficiency virus type 1 (HIV-1) drug resistance mutations (DRMs) and compare the therapeutic outcomes of different antiretroviral treatment regimens in newly diagnosed HIV-1-infected patients with the V179D/E mutation. METHODS: This study included newly diagnosed HIV-1-infected individuals in Guangzhou from 2020 to 2024. Peripheral venous blood samples were collected, and viral RNA was extracted. The pol region of HIV genome was amplified and sequenced. Genotypic resistance testing was performed on the obtained pol gene sequences, and the prevalence of DRMs was analyzed. The efficacy of efavirenz (EFV)-based and non-EFV-based regimens in patients with V179D/E mutation was compared using cumulative failure rate curves. RESULTS: Of 740 enrolled patients who underwent baseline resistance testing, 198 (26.76%) harbored DRMs, of whom 59 (7.97%) exhibited pretreatment drug resistance (PDR). The predominant HIV subtypes were CRF07_BC and CRF01_AE. Non-nucleoside reverse transcriptase inhibitors (NNRTIs) were associated with a DRM prevalence rate of 22.16% (n = 164/740), with common mutation sites being V179E (45.96%, n = 91/198) and V179D (12.12%, n = 24/198). 58.9% of patients with V179D/E mutations received EFV-based regimens (EFV group, n = 66/112), while 41.1% (46/112) used integrase strand transfer inhibitors (INSTIs) or protease inhibitors (PIs)-based regimens (non-EFV group, n = 46). Besides, the EFV group exhibited significantly higher treatment failure rates than the non-EFV group (p = 0.0131). CONCLUSION: The prevalence of DRMs in newly diagnosed HIV-1-infected individuals in Guangzhou associated with NNRTIs is 22.16%, primarily driven by the V179D/E mutation. EFV-based treatments were associated with higher cumulative virological failure rates in patients with V179D/E mutation.