Objective To analyze influencing factors of antiretroviral therapy (ART) resistance among human immuno-deficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in Shandong province.

Methods During 2020 in Shandong province, viral load detection was conducted among 12 608 HIV/AIDS patients aged ≥ 15 years and receiving ART more than 6 months and HIV drug resistance genotyping was performed for the 564 patients with ART failure (viral load > 1 000 copies/mL). Of the 477 ART failure patients with successful PCR amplification and HIV sequencing, 218 were assessed as having resistance to one or more antiretroviral drugs based on the results of HIV sequencing referring to the Stanford HIV Resistance Database. Then, a face-to-face interview with a self-designed questionnaire was carried out among 100 of the 218 ART resistance cases and 131 gender-, age-, current address-matched controls selected from the HIV patients sensitive to ART. Chi-square test, Fisher′s exact probability test and logistic regression model were used to analyze factors related to ART resistance.

Results For the 12 521 HIV/AIDS patients completing the viral load detection, 218 (1.74%) were resistant to ART. Valid responses were obtained from 97 cases and 126 controls in the questionnaire interview. Logistic regression analysis revealed following risk factors of ART resistance: with delayed treatment of 1 – 12 months compared to the treatment in time (adjusted odd ratio aOR = 2.74, 95% confidence interval 95%CI: 1.18 – 6.33), frequency of ART regimen change (once: aOR = 12.62, 95%CI: 5.44 – 29.23; twice: aOR = 39.96, 95%CI: 10.10 – 158.15; and thrice: aOR = 12.01, 95%CI: 1.60 – 90.40), and without supervision on ART (aOR = 3.08, 95%CI: 1.39 – 6.84); the analysis also showed that moderate adherence (aOR = 0.10, 95%CI: 0.04 – 0.27) and high adherence (aOR = 0.07, 95%CI: 0.02 – 0.19) to ART were protective factors against ART resistance.

Conclusion Delayed time of ART, changing ART regimen and without supervision on ART are risk factors but high compliance to ART is a protective factor for ART resistance among HIV/AIDS patients receiving ART in Shandong province.