{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T12:01:41Z","timestamp":1790337701901,"version":"4.1.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"National Science and Technology Major Project for Prevention and Control of Emerging, Re-emerging and Major Infectious Diseases","award":["2025ZD01904701"],"award-info":[{"award-number":["2025ZD01904701"]}]},{"name":"Zhejiang Provincial Science and Technology Program for Disease Prevention and Control","award":["2025JK190"],"award-info":[{"award-number":["2025JK190"]}]},{"name":"Zhejiang Provincial Science and Technology Program for Disease Prevention and Control","award":["2025JK166"],"award-info":[{"award-number":["2025JK166"]}]},{"name":"Zhejiang Provincial Science and Technology Program for Disease Prevention and Control","award":["2026JKY099"],"award-info":[{"award-number":["2026JKY099"]}]},{"name":"Zhejiang Provincial Medicine and Health Science and Technology Plan","award":["2025KY771"],"award-info":[{"award-number":["2025KY771"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize the epidemiology, subtype distribution and transmission dynamics of pre-treatment drug resistance (PDR) among newly diagnosed antiretroviral therapy (ART)-naive individuals with human immunodeficiency virus type 1 (HIV-1) in Zhejiang Province, Eastern China, in 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this province-wide cross-sectional molecular epidemiological study, the HIV-1 pol gene was amplified and Sanger-sequenced. Genotypic resistance was interpreted using the Stanford HIV Drug Resistance Database, subtypes were assigned by phylogenetic analysis, and transmission networks were inferred at a pairwise genetic distance threshold of 0.01 substitutions\/site, with sensitivity analysis across 0.001\u20130.015 substitutions\/site thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3466 valid pol sequences, 241 PDR cases were identified, yielding an overall PDR prevalence of 6.95% [95% confidence interval (CI): 6.11%\u20137.80%], with the highest prevalence observed in Jinhua (10.02%; 95% CI: 7.39%\u201312.65%). Of the 241 PDR cases, 10 distinct HIV-1 subtypes were detected, among which CRF07_BC (43.57%, 105\/241) and CRF01_AE (38.17%, 92\/241) predominated. Non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance was most frequent (67.66%, 159\/235), driven by the resistance-associated mutation (RAM) K103N\/S (46.47%, 112\/241); high-level resistance was highest for nevirapine (63.07%, 152\/241) and efavirenz (54.77%, 132\/241). Overall, 42.32% of PDR cases clustered into 51 resistance-associated transmission clusters (RTCs); 18 medium\/large RTCs (\u22654 individuals) carried high-level NNRTI resistance, 8 with mean pairwise distances \u22640.005 substitutions\/site, suggesting high sequence homology and suggestive of close epidemiological linkage among clustered strains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this study, PDR cases in Zhejiang were dominated by NNRTI resistance with substantial regional clustering, indicating putative transmission networks. Scaled-up standardized PDR surveillance, optimized first-line ART regimens and cluster-targeted interventions are urgently needed to curb resistant HIV-1 transmission and inform national HIV drug resistance policy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkag299","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T18:24:36Z","timestamp":1789755876000},"source":"Crossref","is-referenced-by-count":0,"title":["Pre-treatment HIV-1 drug resistance spectrum and molecular transmission network characteristics in Zhejiang Province, 2023: implications for targeted control of drug-resistant HIV transmission"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1887-9776","authenticated-orcid":false,"given":"Qin","family":"Fan","sequence":"first","affiliation":[{"name":"Department of HIV\/AIDS and STDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , No.3399, Binsheng 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