Molecular epidemiological analysis and investigation of antiretroviral drug resistance profile, including capsid inhibitors, among treatment‐naïve individuals with HIV‐1 in Türkiye

Introduction Monitoring transmitted drug resistance is crucial for guiding first‐line antiretroviral therapy (ART) and controlling the rising HIV epidemic in Türkiye. This study aimed to determine the prevalence of transmitted antiretroviral resistance to protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs), non‐nucleoside reverse transcriptase inhibitors (NNRTIs), integrase strand transfer inhibitors (INSTIs) and capsid assembly inhibitors (CAIs). We also assessed the distribution of HIV‐1 subtypes and circulating recombinant forms (CRFs) at one of the main national referral centres in Türkiye. Methods We included 104 consecutive ART‐naïve people living with HIV who presented at Hacettepe University Hospital in Ankara between November 2021 and November 2022. Demographic data, probable transmission routes and geographic origins were recorded. HIV‐1 genotyping was performed to identify subtypes and resistance‐associated mutations using standard methods. Results Of the 104 individuals, 97 were from 25 different cities in Türkiye, while 7 originated from 5 different countries. The most probable transmission routes were men who have sex with men (MSM) (64.42%), heterosexual contact (30.77%) and unknown (4.81%). Resistance‐associated mutations were detected in 14.42% of individuals. Resistance rates were 1.92% for PI, 4.80% for NRTI and 7.69% for NNRTI. No resistance mutations were found against INSTI or CAI. Conclusion Transmitted resistance to PI, NRTI and NNRTI remains present in Türkiye, though at moderate levels. The absence of resistance to INSTI and CAI supports their potential utility as effective components of treatment regimens in Türkiye.