Presence of the M184I mutation after short-term exposure to azvudine for COVID-19 in people living with HIV

Abstract

Azvudine is a nucleoside analog that inhibits HIV-1 RNA-dependent RNA polymerase and is also an agent against SARS-CoV-2 [1]. It was first approved in China in July 2022 as the treatment for COVID-19 [2] and then approved in Russia in February 2023. The reverse transcriptase M184V/I mutation has historically been common in regimens that contain lamivudine (3TC) or emtricitabine (FTC) [3]. An in-vitro study demonstrated that M184I is the key mutation in azvudine treatment [4]. Here, we report M184I mutation in five HIV-1 individuals who take azvudine before initiating antiretroviral therapy (ART) in Shanghai Public Health Clinical Center (SPHCC), China, as summarized in Table 1. Genotypic resistance testing (GRT) was performed in these individuals according to our previously established protocols [5].