{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T14:30:06Z","timestamp":1780929006783,"version":"3.54.1"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the 2017 Ningxia Young Top Talent Project","award":["No. [2017] 787"],"award-info":[{"award-number":["No. [2017] 787"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The high mutability of human immunodeficiency virus type 1 (HIV-1) and the widespread use of antiretroviral drugs have rendered genetic diversity and pre-treatment drug resistance (PDR) significant obstacles to the success of antiretroviral therapy (ART). However, the research on the epidemiological and spatial distribution characteristics of PDR in Ningxia is still insufficient. A cross-sectional study utilized pre-treatment blood samples collected between 2020 and 2021 from the biorepository in May 2024. Partial pol gene sequences were obtained through plasma collection and RNA extraction. Drug resistance analysis was performed using the Stanford University HIVdb algorithm. Molecular network were constructed using Cytoscape 3.10.0. Spatial analysis and visualization were further conducted using ArcGIS10.8.1. 95 sequences were obtained, among which 7 HIV-1 genotypes were detected and CRF07_BC (67.37%, 64\/95) was the predominant one. Drug resistance mutations (DRMs) were detected in 13.68%(13\/95) of the sequences. The risk of PDR occurrence was higher among individuals with CRF07_BC strain types. The 24 sequences of CRF07_BC, CRF01_AE, and URF subtypes grouped into nine transmission clusters in the molecular network, with CRF07_BC showing the highest integration and clustering rates. HIV-1 infections resistant to PDR were observed in all five cities in NHAR, accompanied by cross-city transmission. Additionally, seven imported sequences were detected, comprising CRF07_BC, CRF01_AE, and C subtypes, along with three sequences of CRF55_01B with high similarity to nonlocal sequences. From 2020 to 2021, the HIV-1 diversity increased significantly in NHAR, with the prevalence of PDR reaching moderate levels and evidence of resistance transmission. The districts and counties under the jurisdiction of Yinchuan City emerged as hotspots for both pre-treatment HIV\/AIDS patients and the distribution of resistant strains. It is imperative to enhance PDR testing and implement targeted interventions in key areas to minimize the emergence and dissemination of resistant virus variants.<\/jats:p>","DOI":"10.1371\/journal.pone.0322389","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T17:23:22Z","timestamp":1745342602000},"page":"e0322389","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Epidemiological and spatial analysis of newly diagnosed HIV-1\/AIDS patients before antiretroviral therapy in Ningxia from 2020 to 2021"],"prefix":"10.1371","volume":"20","author":[{"given":"Yichang","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofa","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianxin","family":"Pei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongzhi","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yufeng","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohong","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3420-1268","authenticated-orcid":true,"given":"Zhonglan","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,4,22]]},"reference":[{"issue":"7341","key":"pone.0322389.ref001","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1136\/bmj.324.7341.803","article-title":"Epidemiology of HIV in China","volume":"324","author":"K Zhang Kl","year":"2002","journal-title":"BMJ"},{"issue":"3","key":"pone.0322389.ref002","doi-asserted-by":"crossref","first-page":"e0119989","DOI":"10.1371\/journal.pone.0119989","article-title":"The combination of phylogenetic analysis with epidemiological and serological data to track HIV-1 transmission in a sexual transmission case","volume":"10","author":"M Chen","year":"2015","journal-title":"PLoS One"},{"issue":"48","key":"pone.0322389.ref003","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.46234\/ccdcw2021.249","article-title":"Research progress in the epidemiology of HIV\/AIDS in China","volume":"3","author":"N He","year":"2021","journal-title":"China CDC Wkly"},{"key":"pone.0322389.ref004","doi-asserted-by":"crossref","first-page":"965836","DOI":"10.3389\/fmed.2022.965836","article-title":"Molecular transmission network of pretreatment drug resistance among human immunodeficiency virus-positive individuals and the impact of virological failure on those who received antiretroviral therapy in China","volume":"9","author":"H Chen","year":"2022","journal-title":"Front Med (Lausanne)"},{"issue":"7588","key":"pone.0322389.ref005","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1038\/nature16933","article-title":"Persistent HIV-1 replication maintains the tissue reservoir during therapy","volume":"530","author":"R Lorenzo-Redondo","year":"2016","journal-title":"Nature"},{"issue":"10","key":"pone.0322389.ref006","doi-asserted-by":"crossref","first-page":"e490","DOI":"10.1016\/S2352-3018(16)30052-2","article-title":"Mortality in HIV-infected women, heterosexual men, and men who have sex with men in Rio de Janeiro, Brazil: an observational cohort study","volume":"3","author":"L Coelho","year":"2016","journal-title":"Lancet HIV"},{"key":"pone.0322389.ref007","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.meegid.2016.08.031","article-title":"HIV-1 drug resistance and resistance testing","volume":"46","author":"DS Clutter","year":"2016","journal-title":"Infect Genet Evol"},{"key":"pone.0322389.ref008"},{"key":"pone.0322389.ref009"},{"issue":"1","key":"pone.0322389.ref010","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1186\/s12879-021-06847-5","article-title":"Survey of pretreatment HIV drug resistance and the genetic transmission networks among HIV-positive individuals in southwestern China, 2014-2020","volume":"21","author":"X Xu","year":"2021","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0322389.ref011","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s40249-020-00668-5","article-title":"Pretreatment HIV drug resistance in adults initiating antiretroviral therapy in China, 2017","volume":"9","author":"R-H Kang","year":"2020","journal-title":"Infect Dis Poverty"},{"issue":"7","key":"pone.0322389.ref012","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1093\/molbev\/msy016","article-title":"HIV-TRACE (TRAnsmission Cluster Engine): a tool for large scale molecular epidemiology of HIV-1 and other rapidly evolving pathogens","volume":"35","author":"SL Kosakovsky Pond","year":"2018","journal-title":"Mol Biol Evol"},{"issue":"1\u20132","key":"pone.0322389.ref013","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/biomet\/37.1-2.17","article-title":"Notes on continuous stochastic phenomena","volume":"37","author":"PA Moran","year":"1950","journal-title":"Biometrika"},{"issue":"05","key":"pone.0322389.ref014","first-page":"1160","article-title":"Characteristics of genotypes and drug resistance in HIV-infected patients in Yinchuan","volume":"38","author":"YL Wu","year":"2022","journal-title":"Chin J Virol"},{"issue":"04","key":"pone.0322389.ref015","first-page":"431434","article-title":"Research progress of HIV-1 epidemic trend in Shaanxi province","volume":"27","author":"SW Cheng","year":"2021","journal-title":"Chin J AIDS STD"},{"issue":"08","key":"pone.0322389.ref016","first-page":"960","article-title":"Characteristics of drug resistance and gene subtypes of 434 HIV infected patients pre-treatment in Kunming City","volume":"28","author":"ZX Li","year":"2022","journal-title":"Chin J AIDS STD"},{"issue":"05","key":"pone.0322389.ref017","first-page":"851","article-title":"Genetic subtypes and status of transmitted drug resistance of HIV\/AIDS patients in Sichuan","volume":"53","author":"H-X Liu","year":"2022","journal-title":"J Sichuan Univ (Med Sci)"},{"issue":"7","key":"pone.0322389.ref018","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1136\/sextrans-2011-050079","article-title":"Prevalence of bisexual behaviour among bridge population of men who have sex with men in China: a meta-analysis of observational studies","volume":"87","author":"K Yun","year":"2011","journal-title":"Sex Transm Infect"},{"issue":"1","key":"pone.0322389.ref019","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1590\/1982-0194201700003","article-title":"Vulnerabilidade de idosos a infec\u00e7\u00f5es sexualmente transmiss\u00edveis","volume":"30","author":"J Andrade","year":"2017","journal-title":"Acta Paul Enferm"},{"issue":"6","key":"pone.0322389.ref020","doi-asserted-by":"crossref","first-page":"e37491","DOI":"10.2196\/37491","article-title":"The distribution of HIV and AIDS cases in Luzhou, China, From 2011 to 2020: Bayesian spatiotemporal analysis","volume":"8","author":"N Ren","year":"2022","journal-title":"JMIR Public Health Surveill"},{"issue":"5","key":"pone.0322389.ref021","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1007\/s10461-024-04281-7","article-title":"Behavior change among HIV-negative men who have sex with men not using prep in the United States","volume":"28","author":"SM Goodreau","year":"2024","journal-title":"AIDS Behav"},{"issue":"7","key":"pone.0322389.ref022","doi-asserted-by":"crossref","first-page":"e17788","DOI":"10.2196\/17788","article-title":"HIV Self-testing to promote serostatus disclosure among men who have sex with men in China: protocol for a stepped wedge randomized controlled trial","volume":"9","author":"T Lu","year":"2020","journal-title":"JMIR Res Protoc"},{"key":"pone.0322389.ref023","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1177\/135965350801302S04","article-title":"Recommendations for surveillance of transmitted HIV drug resistance in countries scaling up antiretroviral treatment","author":"DE Bennett","year":"2008","journal-title":"Antivir Ther"},{"issue":"09","key":"pone.0322389.ref024","first-page":"1354","article-title":"Prevalence of bisexual behaviour among bridge population of men who have sex with men in China: a meta-analysis of observational studies","volume":"45","author":"X Fang","year":"2021","journal-title":"Sex Transm Infect"},{"issue":"11","key":"pone.0322389.ref025","first-page":"864","article-title":"Analysis of HIV drug-resistance surveillance among patients receiving antiretroviral therapy in 2015 in a hospital in Gansu province","volume":"22","author":"AL Xu","year":"2016","journal-title":"Chin J AIDS STD"},{"key":"pone.0322389.ref026","volume-title":"Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach [M\/OL]","year":"2021"},{"issue":"1","key":"pone.0322389.ref027","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7448\/IAS.16.1.18567","article-title":"Non-nucleoside reverse transcriptase inhibitors: a review on pharmacokinetics, pharmacodynamics, safety and tolerability","volume":"16","author":"I Usach","year":"2013","journal-title":"J Int AIDS Soc"},{"issue":"07","key":"pone.0322389.ref028","first-page":"500503","article-title":"HIV-1 non-nuclaoside reverse transcriptase inhibitors resistance-associated mutations and viral fitnass","volume":"18","author":"Y Huang","year":"2012","journal-title":"Chin J AIDS STD"},{"issue":"2","key":"pone.0322389.ref029","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1128\/AAC.01032-06","article-title":"A novel nonnucleoside analogue that inhibits human immunodeficiency virus type 1 isolates resistant to current nonnucleoside reverse transcriptase inhibitors","volume":"51","author":"Z Zhang","year":"2007","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0322389.ref030","doi-asserted-by":"crossref","first-page":"e102","DOI":"10.1017\/S095026882000093X","article-title":"The characteristics of pretreatment HIV-1 drug resistance in western Yunnan, China","volume":"148","author":"M Chen","year":"2020","journal-title":"Epidemiol Infect"},{"key":"pone.0322389.ref031","doi-asserted-by":"crossref","first-page":"797771","DOI":"10.3389\/fmicb.2021.797771","article-title":"Molecular network analysis reveals transmission of HIV-1 drug-resistant strains among newly diagnosed HIV-1 Infections in a moderately HIV Endemic City in China","volume":"12","author":"B Zhao","year":"2021","journal-title":"Front Microbiol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0322389","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T17:23:31Z","timestamp":1745342611000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0322389"}},"subtitle":[],"editor":[{"given":"Janin","family":"Nouhin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,22]]},"references-count":31,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0322389","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,22]]}}}