HIV-1 Drug Resistance among Treatment-Naïve Patients in Russia: Analysis of the National Database, 2006-2022

Abstract

In Russia, antiretroviral therapy (ART) coverage has significantly increased, which, in the absence of routine genotyping testing, could lead to an increase in HIV drug resistance (DR). The aim of this study was to investigate the patterns and temporal trends in HIV DR as well as the prevalence of genetic variants in treatment-naïve patients from 2006 to 2022, using data from the Russian database (4481 protease and reverse transcriptase and 844 integrase gene sequences). HIV genetic variants, and DR and DR mutations (DRMs) were determined using the Stanford Database. The analysis showed high viral diversity, with the predominance of A6 (78.4%), which was the most common in all transmission risk groups. The overall prevalence of surveillance DRMs (SDRMs) was 5.4%, and it reached 10.0% in 2022. Most patients harbored NNRTI SDRMs (3.3%). The prevalence of SDRMs was highest in the Ural (7.9%). Male gender and the CRF63_02A6 variant were association factors with SDRMs. The overall prevalence of DR was 12.7% and increased over time, primarily due to NNRTIs. Because baseline HIV genotyping is unavailable in Russia, it is necessary to conduct surveillance of HIV DR due to the increased ART coverage and DR prevalence. Centralized collection and unified analysis of all received genotypes in the national database can help in understanding the patterns and trends in DR to improve treatment protocols and increase the effectiveness of ART. Moreover, using the national database can help identify regions or transmission risk groups with a high prevalence of HIV DR for epidemiological measures to prevent the spread of HIV DR in the country.

Keywords: HIV-1; Russia; database; drug resistance; treatment-naïve.

Figure 1

Prevalence of HIV-1 genetic variants in the FDs of Russia. * Others (other HIV-1 genetic variants) include CRF01_AE, A1, 19_cpx, 14_BG, CRF01_AE/B, CRF20_BG, 56_cpx, C, 11_cpx, CRF06_cpx, and F1. Abbreviation: CRF, circulating recombinant form.

Figure 2

Temporal trends in SDRMs in Russia in the 2006–2022 sampling years. The range of the 95% confidence interval is represented as a blue cloud around a line. Abbreviation: SDRMs, surveillance drug resistance mutations.

Figure 3

Prevalence of SDRMs in FDs of Russia in the 2006–2022 sampling years. The range of the 95% confidence interval is enclosed in square brackets.

Figure 4

HIV DR prevalence in Russia in the 2006–2022 sampling years by (a) drug class and (b) antiretroviral drugs with DR levels. PR-RT (n = 4481) and INT (n = 844) sequences were used to analyze DR to NRTIs, NNRTIs, PIs, and INSTIs, respectively. Error bars represent 95% CIs. Abbreviations: NRTI, nucleoside reverse transcriptase inhibitor; NNRTI, non-nucleoside reverse transcriptase inhibitor; PI, protease inhibitor; INSTI, integrase strand transfer inhibitor; MDR, multidrug-resistance; ABC, abacavir; AZT, zidovudine; FTC, emtricitabine; 3TC, lamivudine; TDF, tenofovir; d4T, stavudine; ddI, didanosine; DOR, doravirine; EFV, efavirenz; ETR, etravirine; NVP, nevirapine; RPV, rilpivirine; ATV, atazanavir; DRV, darunavir; LPV, lopinavir; FPV, fosamprenavir; IDV, indinavir; NFV, nelfinavir; SQV, saquinavir; TPV, tipranavir; BIC, bictegravir; CAB, cabotegravir; DTG, dolutegravir; EVG, elvitegravir; RAL, raltegravir.

Figure 5

Temporal trends in HIV DR in Russia in the 2006–2022 sampling years by drug class. PR-RT (n = 4481) and INT (n = 844) sequences were used to analyze DR to NRTIs, NNRTIs, PIs, and INSTIs, respectively. Abbreviations: PI, protease inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; NNRTI, non-nucleoside reverse transcriptase inhibitor; INSTI, integrase strand transfer inhibitor.