Multidrug-Resistance of HIV-1 in Adult Patients in Russia in 2024–2025

The purpose. To assess the prevalence of HIV-1 drug resistance and multidrug resistance to antiretroviral drugs in adult patients with and without treatment experience in Russia in 2024–2025.
Materials and Methods. A total of 1888 plasma samples from adult HIV-infected patients from 21 regions of Russia were analyzed. The average age of the patients was 42,08 years; 60,86% were men and 39,14% were women. 77,65% of patients had information about treatment experience; 28,04% of these patients were treatment-naive and 71,96% were treatment-experienced. Consensus nucleotide sequences of the pol gene, encoding HIV-1 protease, reverse transcriptase, and integrase, were obtained using next-generation sequencing. HIV-1 drug resistance analysis was conducted using the Stanford University HIVdb database.
Results. The most common HIV-1 surveillance mutations were substitutions in the reverse transcriptase – M184V and K103N. In treatment-experienced patients, high levels of HIV-1 resistance were observed to NNRTIs (efavirenz) and NRTIs (lamivudine, abacavir), and in treatment-naive patients – to NNRTIs (efavirenz, nevirapine, rilpivirine). Low levels of HIV-1 resistance were observed to protease and integrase inhibitors, including dolutegravir. The most common combinations of surveillance mutations in treatment-experienced patients were G190S + K101E, G190S + M184V, K65R + M184V, K103N + M184V and G190S + K65R + Y181C. The most common combination of HIV-1 multidrug resistance was NRTI + NNRTI resistance.
Conclusion. Early detection of drug resistance mutations using next-generation sequencing (NGS) followed by quasispecies analysis can significantly change the approach to choosing first- and subsequent-line etiotropic treatment regimens and improve the clinical and cost-effectiveness of HIV-1 treatment.

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