ABSTRACTOBJECTIVE For the past decade, the incidence of HIV has been on the rise in Eastern Europe and Central Asia, including the former Soviet Union (FSU) countries. Visa-free cross-border mobility in FSU nations has given rise to autochthonous transmission and emergence of region-specific pathogens. For this study, we analyzed drug resistance mutations (DRMs) in HIV-1 A6, the most prevalent subtype in the FSU region. METHODS Using the Stanford database, we analyzed DRMs in 12,295 HIV-1 A6 pol sequences from 14 FSU countries. Using the Nextstrain pipeline, maximum-likelihood approach was employed to perform phylogenetic and phylogegraphic analyses. RESULTS The most prevalent DRMs identified were nucleoside reverse transcriptase inhibitor (NRTI) DRMs A62V (39%) and M184V (18%); and non-nucleoside reverse transcriptase inhibitor (NNRTI) DRMs G190S (11%) and K103N (7%). Protease inhibitor DRMs were also detected at lower frequencies. Phylogenetic analyses revealed Russia, Ukraine, and Belarus to be significant hubs of A6 transmission, exhibiting overlapping clusters of sequences harboring NRTI and NNRTI DRMs were revealed – highlighting cross-border transmission of HIV variants harboring multiple-drug resistance. CONCLUSIONS Our findings underscore the importance of regular surveillance of emerging DRMs across all major drug classes, including NRTIs, NNRTIs, and PIs, and tailored optimization of ART regimens in the FSU region.
Bakuova et al. (Sun,) studied this question.