Objective To systematically evaluate the rate of pre-treatment drug resistance (PDR)and its influencing factors in human immunodeficiency virus (HIV)-infected individuals in China from 2016 to 2025. Methods PubMed, Web of Science, Embase, the Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Database were retrieved, with a retrieval period from the establishment of the databases to November 1, 2025. Two researchers independently screened literature, extracted data, and evaluated quality of the studies. Meta-analysis was performed with Stata 18.0 software. Results A total of 50 literatures were included in analysis, involving 28 662 infected individuals. There was significant heterogeneity among the studies (I²=93.2%, P<0.001). Meta-analysis results showed that from 2016 to 2025, the rate of PDR in HIV-infected individuals in China was 10%, with a resistance rate of 7% to non-nucleoside reverse transcriptase inhibitors (NNRTIs), 2% to nucleoside reverse transcriptase inhibitors (NRTIs), and 1% to protease inhibitors (PIs). CD4⁺ cell count < 200 cells/μL (OR=1.60, 95%CI: 1.24-2.06), drug injection (OR=2.52, 95%CI: 1.73-3.66), female (OR=2.11, 95%CI: 1.22-3.64), genotype CRF07_BC (OR=0.63, 95%CI: 0.49-0.83), genotype CRF55_01B (OR=6.90, 95%CI: 3.99-11.94), and genotype B (OR=3.35, 95%CI: 2.31-4.85) were all influencing factors of PDR in HIV-infected individuals (all P<0.05). Conclusion The rate of PDR in HIV-infected individuals in China is relatively high. It is necessary to strengthen the surveillance of PDR among HIV-infected individuals, take targeted measures, and improve the supervision system, so as to reduce the spread of drug-resistant strains. The heterogeneity of drug resistance rate among studies is high, and subgroup analysis failed to reduce its heterogeneity, which may be related to differences in HIV prevention and control resources, urban education development levels, and HIV gene subtype distribution in different regions.