---
title: "HIV-1 Transmitted Drug Resistance in Shanghai (2018–2024): Mobility Fuels Cross-Population Spread"
id: "pubmed-42758933"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42758933"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42758933/"
doi: "10.1080/22221751.2026.2731504"
published_at: "2026-09-18T12:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# HIV-1 Transmitted Drug Resistance in Shanghai (2018–2024): Mobility Fuels Cross-Population Spread
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42758933
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42758933/)
- **DOI:** [10.1080/22221751.2026.2731504](https://doi.org/10.1080%2F22221751.2026.2731504)
- **Published At:** 2026-09-18T12:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Study analyzed HIV-1 pol sequences from 7,538 newly diagnosed, treatment-naïve people in Shanghai collected between 2018 and 2024, using genotypic resistance testing, molecular transmission network analysis, and time-scaled discrete phylogeography. - Overall prevalence of **transmitted drug resistance (TDR)** was 5.1% (95% CI: 4.6%–5.6%). - TDR prevalence was higher among individuals with recent infection (7.3%, 95% CI: 5.6%–9.5%) and this association was statistically significant (P = 0.004). - Resistance associated with **NNRTIs** rose significantly over the study period (adjusted P = 0.009), driven mainly by the mutation **K103N/S**. - Multivariable analysis identified recent infection (AOR = 1.66) and resident migrant status (AOR = 1.31) as independent correlates of TDR. - TDR sequences clustered non-randomly within transmission networks (P < 0.001); 59.2% of networked TDR sequences were concentrated in 2.7% of clusters. - Phylogeographic reconstruction showed substantial cross-population linkages of TDR lineages, with both temporary and resident migrants contributing disproportionately to TDR introductions into Shanghai. - Resident migrants had high network participation (44.1%), were overrepresented in TDR transmission clusters (78.9%), and accounted for a large share of TDR–TDR network edges (74.3%), suggesting they may connect non-local and local transmission networks. - Authors conclude that population mobility shapes a structured pattern of TDR dissemination and recommend targeted surveillance in highly mobile urban settings.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 18. # HIV-1 transmitted drug resistance in Shanghai, 2018-2024: population mobility shapes cross-population TDR transmission dynamics [Yuan Dong](https://pubmed.ncbi.nlm.nih.gov/?term=Dong+Y&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Qianru Lin](https://pubmed.ncbi.nlm.nih.gov/?term=Lin+Q&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Xuqin Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+X&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Changhe Liu](https://pubmed.ncbi.nlm.nih.gov/?term=Liu+C&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Xiaolei Yu](https://pubmed.ncbi.nlm.nih.gov/?term=Yu+X&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Wenqi Tang](https://pubmed.ncbi.nlm.nih.gov/?term=Tang+W&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Wanqing Feng](https://pubmed.ncbi.nlm.nih.gov/?term=Feng+W&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Xiaoning Lv](https://pubmed.ncbi.nlm.nih.gov/?term=Lv+X&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Yiqing Han](https://pubmed.ncbi.nlm.nih.gov/?term=Han+Y&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Qing Yue](https://pubmed.ncbi.nlm.nih.gov/?term=Yue+Q&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Zhen Ning](https://pubmed.ncbi.nlm.nih.gov/?term=Ning+Z&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Xin Shen](https://pubmed.ncbi.nlm.nih.gov/?term=Shen+X&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Xin Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+X&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Yanqiu Zhou](https://pubmed.ncbi.nlm.nih.gov/?term=Zhou+Y&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Min Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+M&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Huanyu Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+H&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Yi Lin](https://pubmed.ncbi.nlm.nih.gov/?term=Lin+Y&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#full-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China.") Affiliations Expand ### Affiliation * 1 Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China. * PMID: **42758933** * DOI: [ 10.1080/22221751.2026.2731504 ](https://doi.org/10.1080/22221751.2026.2731504) Item in Clipboard # HIV-1 transmitted drug resistance in Shanghai, 2018-2024: population mobility shapes cross-population TDR transmission dynamics Yuan Dong et al. Emerg Microbes Infect. 2026 Dec. Show details Display options Display options Format Abstract PubMed PMID Emerg Microbes Infect Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Emerg+Microbes+Infect%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Emerg+Microbes+Infect%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42758933/) . 2026 Dec;15(1):2731504. doi: 10.1080/22221751.2026.2731504. Epub 2026 Sep 18. ### Authors [Yuan Dong](https://pubmed.ncbi.nlm.nih.gov/?term=Dong+Y&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Qianru Lin](https://pubmed.ncbi.nlm.nih.gov/?term=Lin+Q&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Xuqin Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+X&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Changhe Liu](https://pubmed.ncbi.nlm.nih.gov/?term=Liu+C&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Xiaolei Yu](https://pubmed.ncbi.nlm.nih.gov/?term=Yu+X&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Wenqi Tang](https://pubmed.ncbi.nlm.nih.gov/?term=Tang+W&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Wanqing Feng](https://pubmed.ncbi.nlm.nih.gov/?term=Feng+W&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Xiaoning Lv](https://pubmed.ncbi.nlm.nih.gov/?term=Lv+X&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Yiqing Han](https://pubmed.ncbi.nlm.nih.gov/?term=Han+Y&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Qing Yue](https://pubmed.ncbi.nlm.nih.gov/?term=Yue+Q&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Zhen Ning](https://pubmed.ncbi.nlm.nih.gov/?term=Ning+Z&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Xin Shen](https://pubmed.ncbi.nlm.nih.gov/?term=Shen+X&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Xin Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+X&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Yanqiu Zhou](https://pubmed.ncbi.nlm.nih.gov/?term=Zhou+Y&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Min Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+M&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Huanyu Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+H&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China."), [Yi Lin](https://pubmed.ncbi.nlm.nih.gov/?term=Lin+Y&cauthor_id=42758933)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758933/#short-view-affiliation-1 "Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China.") ### Affiliation * 1 Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China. * PMID: **42758933** * DOI: [ 10.1080/22221751.2026.2731504 ](https://doi.org/10.1080/22221751.2026.2731504) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract Transmitted drug resistance (TDR) poses a growing challenge to HIV control, particularly in highly mobile urban settings with complex transmission dynamics. We analyzed HIV-1 _pol_ sequences from 7,538 newly diagnosed, treatment-naïve individuals in Shanghai (2018-2024), integrating genotypic resistance testing, molecular transmission network analysis, and time-scaled discrete phylogeographic inference. Individuals with Shanghai hukou were classified as Shanghai residents, whereas those without Shanghai hukou were categorized by residence as resident migrants (residing in Shanghai) or temporary migrants (residing outside Shanghai). Overall TDR prevalence was 5.1% (95% CI: 4.6%-5.6%), and was higher among individuals with recent infections (7.3%, 95% CI: 5.6%-9.5%; _P_ = 0.004). Non-nucleoside reverse transcriptase inhibitors (NNRTIs)-associated resistance increased significantly over the study period (adjusted _P_ = 0.009) driven primarily by K103N/S. In multivariable analysis, TDR was independently associated with recent infection (AOR = 1.66) and resident migrant status (AOR = 1.31). TDR sequences exhibited significant non-random clustering across transmission networks (_P_ < 0.001), with 59.2% of networked TDR sequences concentrated in 2.7% of transmission clusters. Phylogeographic analyses indicated substantial cross-population linkages of TDR-associated lineages, with both temporary and resident migrants contributing disproportionately to TDR introduction. Resident migrants showed substantial network participation (44.1%), were overrepresented in TDR transmission clusters (78.9%), and disproportionately involved in TDR-TDR edges (74.3%), suggesting they may facilitate connectivity between non-local and local transmission networks. These findings support a structured pattern of TDR dissemination and highlight the role of population mobility in cross-population TDR dynamics, informing targeted surveillance in highly mobile urban settings. **Keywords:** HIV-1; molecular transmission network; phylogeography; population mobility; transmitted drug resistance. 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