{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:04:45Z","timestamp":1789538685687,"version":"build-2803163510"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore the epidemic trends of pretreatment drug resistance (PDR) and acquired drug resistance (ADR) among people living with HIV (PLWH) from 2014 to 2024 in Chongqing, China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Samples and clinical data of PLWH were collected from 2014 to 2024. The HIV-1 pol gene was amplified using One-step reverse transcription-polymerase chain reaction (RT-PCR) and nested PCR. HIV-1 drug resistance and subtype were analyzed by the HIV drug resistance database of Stanford University. Logistic regression analysis was identified the risk factor associated with HIV drug resistance (HIVDR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In this study, a total 1,299 ART-naive PLWH and 2,700 ART-experienced PLWH were enrolled. The overall prevalence of PDR was 22.47% with initial increases followed by decreases during 2014\u20132024; the overall prevalence of ADR was 43.63% with a decreasing trend. Among PLWH with PDR and ADR, high-level resistance to lamivudine (3TC) and emtrictitabine (FTC)was prevalent, whereas potential low-level resistance to protease inhibitors (PIs) and integrase strand transfer inhibitor (INSTIs) was predominant. For NNRTIs, a high proportion of potential low-level resistance was observed in patients with PDR; by contrast, nevirapine (NVP) and efavirenz (EFV) showed a high proportion of high-level resistance in the ADR population. Notably, high prevalence of resistance to various antiretroviral therapy (ART) drugs was observed in the dominant HIV-1 CRF07_BC subtype. M184V (NRTI-associated mutation) and V179D (NNRTI-associated mutation) were the most frequently identified observed in PDR and ADR sequences; in contrast, the prevalent drug resistance mutation sites associated with PIs and INSTIs differed between PDR and ADR cases. In CRF07_BC with PDR and ADR, the most prevalent mutations were V179D and M184V, respectively. Furthermore, distinct patterns of drug resistance mutations associated with different ART regimens were observed when comparing PDR and ADR populations. Among ART-naive PLWH, females and CRF08_BC were identified as significant risk factors for HIVDR. In contrast, among ART-treated PLWH, risk factors such as HIV-1 subtypes and ART regimens were associated with HIV drug resistance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Collectively, these results revealed the distinct epidemiological profiles of PDR and ADR in Chongqing area, underscoring the necessity of sustained, routine surveillance of PDR and ADR, and providing strong support to guide personalized regimen selection and reduce the risk of virological failure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1923017","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:31:40Z","timestamp":1789536700000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and transmission of pretreatment drug resistance and acquired drug 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