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This study aims to assess the prevalence and characteristics of PDR, infer the genetic transmission network, and evaluate the effect of PDR on ART in Nanning City, Guangxi. Methods: This study was conducted in the Fourth People\u2019s Hospital of Nanning from 2019 to 2023. PDR was estimated using the Stanford algorithm. Genetic transmission networks were inferred by HIV-TRACE and visualized with Cytoscape. Logistic regression identified PDR-related factors. The Cox proportional hazards model assessed the impact of drug resistance on virological and immunological failure. Among 234 participants, the prevalence of PDR was 8.97%. CRF07_BC (35.9%), CRF-01AE (27.35%), and CRF08_BC (23.9%) were the top three HIV-1 strains. Resistance to non-nucleoside reverse-transcriptase inhibitors, protease inhibitors, nucleoside reverse-transcriptase inhibitors, and integrase strand-transfer inhibitors was 4.27%, 2.56%, 1.28%, and 0.43%, respectively. Overall, 21.37% of the participants exhibited drug resistance mutations (DRMs). Homosexuals were less likely to have PDR compared to heterosexuals ([aOR] 0.09, 95% CI 0.01\u20130.86). In the genetic network, V179D\/E was also the most frequent DRM. Additionally, the incidence of virological failure (19.23%) and immune failure (20.09%) after one year of treatment did not show significant differences in different drug resistance groups. Conclusions: The prevalence of PDR in Nanning City is moderate, driven largely by the V179D and K103N mutations. The cross-transmission networks emphasize the imperative of PDR testing and targeted interventions.<\/jats:p>","DOI":"10.3390\/pathogens14040336","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T11:17:57Z","timestamp":1743506277000},"page":"336","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Prevalence of Pretreatment Drug Resistance and Transmission Networks Among Newly Diagnosed HIV-1-Infected Individuals in Nanning, Guangxi, China"],"prefix":"10.3390","volume":"14","author":[{"given":"Qiuqian","family":"Su","sequence":"first","affiliation":[{"name":"Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning 530021, China"},{"name":"School of Public Health, Guangxi Medical University, Nanning 530021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanjun","family":"Li","sequence":"additional","affiliation":[{"name":"The Fourth People\u2019s Hospital of Nanning, Nanning 530023, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Huang","sequence":"additional","affiliation":[{"name":"Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning 530021, China"},{"name":"School of Public Health, Guangxi Medical University, Nanning 530021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liangjia","family":"Wei","sequence":"additional","affiliation":[{"name":"Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning 530021, China"},{"name":"School of Public Health, Guangxi Medical University, Nanning 530021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinfeng","family":"He","sequence":"additional","affiliation":[{"name":"Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning 530021, China"},{"name":"School of Public Health, Guangxi Medical University, Nanning 530021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumei","family":"Huang","sequence":"additional","affiliation":[{"name":"The Fourth People\u2019s Hospital of Nanning, Nanning 530023, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guidan","family":"Mo","sequence":"additional","affiliation":[{"name":"Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning 530021, China"},{"name":"School of Public Health, Guangxi Medical University, Nanning 530021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiao","family":"Qin","sequence":"additional","affiliation":[{"name":"Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning 530021, China"},{"name":"School of Public Health, Guangxi Medical University, Nanning 530021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunxing","family":"Tao","sequence":"additional","affiliation":[{"name":"Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning 530021, China"},{"name":"School of Public Health, Guangxi Medical University, Nanning 530021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinju","family":"Huang","sequence":"additional","affiliation":[{"name":"Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning 530021, China"},{"name":"School of Public Health, Guangxi Medical University, Nanning 530021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7688-4867","authenticated-orcid":false,"given":"Li","family":"Ye","sequence":"additional","affiliation":[{"name":"Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning 530021, China"},{"name":"Biosafety III Laboratory, Life Science Institute, Guangxi Medical University, Nanning 530021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7534-5124","authenticated-orcid":false,"given":"Hao","family":"Liang","sequence":"additional","affiliation":[{"name":"Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning 530021, China"},{"name":"Biosafety III Laboratory, Life Science Institute, Guangxi Medical University, Nanning 530021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingyu","family":"Liang","sequence":"additional","affiliation":[{"name":"Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning 530021, China"},{"name":"Department of Clinical Research, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinping","family":"Huang","sequence":"additional","affiliation":[{"name":"The Fourth People\u2019s Hospital of Nanning, Nanning 530023, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,31]]},"reference":[{"key":"ref_1","unstructured":"UNAIDS (2024, July 01). 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