Evolving HIV ‐1 epidemiology, drug resistance and socio‐demographics among blood donors in Dalian, Northeastern China, 2011–2024

BACKGROUND AND OBJECTIVES: Human immunodeficiency virus type 1 (HIV-1) prevalence among Chinese blood donors has risen over recent decades, showing marked regional variation. Yet molecular epidemiology data among Chinese donors remain limited. MATERIALS AND METHODS: From 2011 to 2024, blood donations in Dalian, Liaoning Province, were screened using HIV antibody and antigen tests combined with multiplex nucleic acid testing. HIV-1 infection rates, molecular characteristics, genetic diversity, drug resistance and donor socio-demographics were analysed. Partial HIV-1 pol sequences were evaluated for drug resistance mutations (DRMs) using the Stanford HIV Drug Resistance Database algorithm. RESULTS: The HIV-1 infection rate peaked at 55.3 per 100,000 donations in 2013 and stabilized at 12-21 per 100,000 in recent years. Most infected donors were young, male, single and first-time donors. Sexual transmission predominated, particularly among men who have sex with men (MSM) (49.8%), of whom 33.8% were repeat donors. Genetic analysis revealed substantial subtype diversity, dominated by CRF01_AE and CRF07_BC, with unique recombinant forms and occasional non-Asian subtypes. Molecular clustering suggested possible test-seeking behaviour. Notably, 6.8% of HIV-positive samples harboured DRMs, mainly against non-nucleoside reverse transcriptase inhibitors, indicating sporadic transmission of resistant strains. CONCLUSION: These findings underscore the need for strengthened pre-donation education and sustained HIV molecular surveillance to protect blood safety and inform public health strategies.