Transmitted HIV-1 drug resistance in Estonian residents and Ukrainian refugees in 2020 and 2022

Abstract

Objectives

We investigated the prevalence of drug resistance mutations (DRMs) in individuals newly diagnosed with HIV-1 in Estonia in 2020 and 2022, and in Ukrainian war refugees living with HIV who arrived in Estonia in 2022.

Methods

HIV-1 genomic RNA was sequenced in protease-reverse transcriptase and integrase (IN) regions. DRMs were determined separately by Stanford University CPR Tool and HIVdb Program. REGA HIV-1 Subtyping Tool and phylogenetic analysis were used for subtyping.

Results

Both regions were successfully sequenced in 79 and 53 individuals in 2020 and 2022 populations, respectively. The DRM rates were 11.4% [95% CI, 5.3%–20.5%] in 2020 and 13.2% [95% CI 5.5%–25.3%] in 2022. There was a low percentage of resistance to IN strand transfer inhibitors: 3.8% [95% CI, 0.8–10.7] in 2020 and 1.9% [95% CI, 0.05–10.1] in 2022. Most Ukrainian war refugees had undetectable VL (57/88, 65%), were women (63%) and majority were infected with subtype A6 viruses. The overall DRM rate for Ukrainian population was 11.5%.

Conclusions

Identifying HIV DRMs using HIVdb Program combined with CPR tools gives comprehensive overview of transmitted drug resistance. Resistance testing might be necessary before initiating antiretroviral therapy if the first-line treatment does not include PI or second-generation IN strand transfer inhibitors.