HIV-1 drug resistance in patients with virological inefficiency on ART in Russia in 2013-2021

Objective. To assess the prevalence and pattern of HIV-1 drug resistance (DR) among patients with virological failure on ART in Russia in 2013 to 2021. Materials and methods. The investigation used plasma samplesfrom 831 HIV-infected patients with virologicalfailure on ART. The nucleotide sequences of the pol gene fragments encoding protease and a part of reverse transcriptase were obtained for all the patients; for 273 of them, the nucleotide sequences of the pol gene fragment encoding HIV-1 integrase were additionally obtained. The Stanford University HIVdb version 9.0 and the REGA HIV-1 Subtyping Tool version 3.0 were used to determine HIV-1 subtypes; the HIV Blast search in the Los Alamos HIV sequence database was applied to clarify the results; the HIVdb version 9.0 was employed to identify resistance mutations and to determine the predictive HIV-1 DR. Results. The sample included mainly the genetic types of virus A6 (728; 87.6%), CRF 02 AG (21; 2.5%), B (59; 7.1%), and CRF6 02A1 (15; 1,8%). 82.4% of patients with ineffective therapy showed a predictive DR to at least one drug: more commonly to NIOT (74.2%) and NNIOt (67.3%), less commonly to AI (12.1%) and IP (9.6%). Resistance to NIOT + NNRTI was simultaneously established in most cases (45.8-57%). Multiclass resistance to IP + NIOT + NNIOT + AI was detected only in 1.1% of cases. Conclusion. There is a need for a centralized HIV-1 DR test for patients with virological falure on ART in order to select effective therapy regimens and to minimize the occurrence and further spread of resistant HIV-1 types in Russia.

HIV-1, drug resistance, resistance mutations, virological failure, antiretroviral therapy