Genotypic Diversity and Pre-Treatment Resistance Characteristic Analysis Among Newly Diagnosed HIV-1-Positive MSM from 2020-2022 in Jiaxing City, China

Background: Since the first recorded HIV-1 infection in 1998, Jiaxing City has seen increasing HIV infections among men who have sex with men (MSM), necessitating targeted research to understand HIV-1 subtypes and drug resistance patterns to improve prevention and treatment strategies. Objectives: The study aimed to assess the variety of HIV-1 subtypes, the pre-treatment drug re-sistance (PDR) among MSM in Jiaxing, China, and transmission dynamics of drug-resistant strains. The findings may contribute to the development of targeted HIV prevention and control strategies for the MSM population. Methods: Plasma samples from all newly reported cases of HIV-1 transmitted through male-to-male sexual contact in Jiaxing City from 2020 to 2022 were retrospectively analyzed. Demo-graphic and epidemiological data were collected. Partial pol gene regions were amplified, se-quenced, and analyzed for drug resistance mutations (DRMs) using the Stanford HIV Drug Re-sistance Database. The Calibrated Population Resistance (CPR) program was utilised to identify Surveillance Drug Resistance Mutation (SDRM). A molecular transmission network was con-structed to investigate the scale of transmitted drug resistance (TDR) strains. Results: We obtained a total of 298 eligible genetic sequences, revealing a diverse distribution of HIV-1 subtypes, with CRF07_BC, CRF01_AE, and CRF55_01B as the most prevalent. Pretreat-ment DRMs were detected in 91 cases (30.5%), yielding an overall PDR prevalence of 11.0%. Resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) was most frequent (5.4% each). TDR prevalence reached 7.0%, showing an increasing trend (2020-2022). The molecular network analysis indicated sporadic dissemination of drug-resistant cases rather than large-scale transmission chains. Conclusion: The convergence of high HIV-1 subtype diversity, elevated PDR prevalence, rising TDR rates, and sporadic resistant strain transmission within MSM networks necessitates the sus-tained resistance surveillance and precision public health interventions.