Unhygienic blood collection caused an outbreak of HIV-1 and HCV infections among blood donors in rural areas in Henan province, China. Partial HIV-1 pol and HCV NS5b gene sequences were obtained from 97 persons infected with HIV-1 to determine the efficacy of treatment, the prevalence of drug-resistant mutations, and the impact of HCV infection on disease progression of infection with HIV-1. After antiretroviral therapy, 60 out of 97 HIV-1-infected blood donors had their HIV-1 RNA levels reduced to an undetectable level. Drug-resistant mutations to reverse transcriptase inhibitors were detected in one-third of treatment failure patients, with K103N as the most frequent mutation. Drug-resistant mutations were not detected in the other two-thirds of treatment-failure patients, suggesting a poor adherence to the treatment. The majority of HIV-1-infected patients (91.8%) were also infected with HCV. Sequence analysis showed that they were infected with HCV subtype 1b (47.5%) or 2a (52.5%). HCV viral loads were significantly higher in patients infected with subtype 2a than in patients infected with HCV subtype 1b, although no differences in HIV-1 viral loads and CD4(+)T cell counts was observed between the two subtypes. These results suggest that improved adherence and treatment regimens will be critical to effectively treat HIV-1 and HCV-coinfected patients in resource-limited areas.