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Sivay MV, Maksimenko LV, Nalimova TM, Nefedova AA, Osipova IP, Kriklivaya NP, Gashnikova MP, Ekushov VE, Totmenin AV, Kapustin DV, Pozdnyakova LL, Skudarnov SE, Ostapova TS, Yaschenko SV, Nazarova OI, Shevchenko VV, Ilyina EA, Novikova OA, Agafonov AP, Gashnikova NM. HIV drug resistance among patients experiencing antiretroviral therapy failure in Russia, 2019-2021. Int J Antimicrob Agents 2024; 63:107074. [PMID: 38154660 DOI: 10.1016/j.ijantimicag.2023.107074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 11/15/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
Increasing HIV drug resistance is an important public health concern. The current study aimed to assess HIV drug resistance among people who live with HIV (PLWH) experiencing virological failure. Blood samples and epidemiological characteristics were collected in four Siberian regions from PLWH experiencing ART failure. Partial pol gene sequences were obtained for the study individuals. Drug resistance mutations (DRMs) were predicted using the Stanford HIVdb Program. The association of HIV DRM with epidemiological characteristics was estimated using logistic regression analysis. Further analysis was performed for children (0-14 y old) and adults (≥15 y old) separately. In total, 815 (89.4%) patients were included in the final dataset. Overall, 501 (61.5%) patients had DRM detected. NRTI DRM was more common in children, while NRTI+NNRTI DRM was more frequent in adults (P < 0.001). Krasnoyarsk region, male sex and high viral load were positively associated with the presence of DRM in adults, while higher CD4 cell count and PI/INSTI-based ART had a negative association. No association between epidemiological characteristics and DRM was identified in children. The remaining 38.5% of patients with virological failure had no DRM detected; those patients were likely to have insufficient ART adherence. Most (55.5%) patients had HIV CRF63_02A6, followed by sub-subtype A6 (39.2%). This study revealed poor ART adherence as a main factor driving ART failure among PLWH in the Siberian region. DRM was detected in over 60% of PLWH experiencing ART failure. The current results highlight an urgent need for the introduction of special programs focusing on ART adherence improvement.
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Affiliation(s)
- Mariya V Sivay
- State Research Center of Virology and Biotechnology 'Vector', Novosibirsk region, Russia.
| | - Lada V Maksimenko
- State Research Center of Virology and Biotechnology 'Vector', Novosibirsk region, Russia
| | - Tatiana M Nalimova
- State Research Center of Virology and Biotechnology 'Vector', Novosibirsk region, Russia
| | - Anastasiya A Nefedova
- State Research Center of Virology and Biotechnology 'Vector', Novosibirsk region, Russia
| | - Irina P Osipova
- State Research Center of Virology and Biotechnology 'Vector', Novosibirsk region, Russia
| | - Nadezda P Kriklivaya
- State Research Center of Virology and Biotechnology 'Vector', Novosibirsk region, Russia
| | - Mariya P Gashnikova
- State Research Center of Virology and Biotechnology 'Vector', Novosibirsk region, Russia
| | - Vasiliy E Ekushov
- State Research Center of Virology and Biotechnology 'Vector', Novosibirsk region, Russia
| | - Alexei V Totmenin
- State Research Center of Virology and Biotechnology 'Vector', Novosibirsk region, Russia
| | | | | | - Sergey E Skudarnov
- Krasnoyarsk Regional Center for Prevention and Control of AIDS, Krasnoyarsk, Russia
| | - Tatyana S Ostapova
- Krasnoyarsk Regional Center for Prevention and Control of AIDS, Krasnoyarsk, Russia
| | - Svetlana V Yaschenko
- Krasnoyarsk Regional Center for Prevention and Control of AIDS, Krasnoyarsk, Russia
| | - Olga I Nazarova
- Omsk City Center for Prevention and Control of AIDS and Other Infectious Diseases, Omsk, Russia
| | - Valery V Shevchenko
- Altai Regional Center for Prevention and Control of AIDS and Other Infectious Diseases, Barnaul, Russia
| | - Elena A Ilyina
- Altai Regional Center for Prevention and Control of AIDS and Other Infectious Diseases, Barnaul, Russia
| | - Olga A Novikova
- Altai Regional Center for Prevention and Control of AIDS and Other Infectious Diseases, Barnaul, Russia
| | - Aleksander P Agafonov
- State Research Center of Virology and Biotechnology 'Vector', Novosibirsk region, Russia
| | - Natalya M Gashnikova
- State Research Center of Virology and Biotechnology 'Vector', Novosibirsk region, Russia
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Shtrek S, Levakhina L, Blokh A, Pasechnik O, Pen’evskaya N. Prevalence and Spectrum of HIV-1 Resistance Mutations in the Siberian Federal District. Viruses 2022; 14:v14102117. [PMID: 36298672 PMCID: PMC9610422 DOI: 10.3390/v14102117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/14/2022] [Accepted: 09/23/2022] [Indexed: 12/01/2022] Open
Abstract
The Siberian Federal District is among the most affected regions with a high prevalence of HIV-infection and is characterized by high HIV-infection incidence rate and high mortality among the HIV-infected population. HIV drug resistance poses a major threat to public health and is associated with increased mortality, HIV incidence, and cost of epidemic control programs. A total of 1281 samples from HIV-infected patients were sequenced and analyzed with the DEONA and HIVdb Program to assess the prevalence of drug resistance mutations in patients in the Siberian Federal District in 2016–2018. The federal surveillance data obtained from 0.5% of HIV-infected patients during the long-term follow-up care in 2021 were also used. The incidence rate of HIV infection in the Siberian Federal District has declined since 2016: from 135.8 per 100 thousand population to 81.1 per 100 thousand population in 2021. Mutations associated with resistance to NRTI and NNRTI were found in 10.3% of the samples in 2016–2018 and in 28.4% of the samples in 2020. The rising prevalence of drug resistance in HIV-infected patients indicates that it is increasingly important to continuously monitor and improve the approaches to the use of effective treatment regimens.
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Affiliation(s)
- Sergey Shtrek
- Omsk Research Institute of Natural Focal Infections, 644050 Omsk, Russia
- Omsk State Medical University, 644050 Omsk, Russia
| | | | - Aleksey Blokh
- Omsk Research Institute of Natural Focal Infections, 644050 Omsk, Russia
- Omsk State Medical University, 644050 Omsk, Russia
| | - Oksana Pasechnik
- Omsk Research Institute of Natural Focal Infections, 644050 Omsk, Russia
- Omsk State Medical University, 644050 Omsk, Russia
- Correspondence:
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van de Klundert MAA, Antonova A, Di Teodoro G, Ceña Diez R, Chkhartishvili N, Heger E, Kuznetsova A, Lebedev A, Narayanan A, Ozhmegova E, Pronin A, Shemshura A, Tumanov A, Pfeifer N, Kaiser R, Saladini F, Zazzi M, Incardona F, Bobkova M, Sönnerborg A. Molecular Epidemiology of HIV-1 in Eastern Europe and Russia. Viruses 2022; 14:v14102099. [PMID: 36298654 PMCID: PMC9609922 DOI: 10.3390/v14102099] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 12/04/2022] Open
Abstract
The HIV epidemic in Eastern Europe and Russia is large and not well-controlled. To describe the more recent molecular epidemiology of HIV-1, transmitted drug resistance, and the relationship between the epidemics in this region, we sequenced the protease and reverse transcriptase genes of HIV-1 from 812 people living with HIV from Ukraine (n = 191), Georgia (n = 201), and Russia (n = 420) before the initiation of antiretroviral therapy. In 190 Ukrainian patients, the integrase gene sequence was also determined. The most reported route of transmission was heterosexual contact, followed by intravenous drug use, and men having sex with men (MSM). Several pre-existing drug resistance mutations were found against non-nucleoside reverse transcriptase inhibitors (RTIs) (n = 103), protease inhibitors (n = 11), and nucleoside analogue RTIs (n = 12), mostly polymorphic mutations or revertants. In the integrase gene, four strains with accessory integrase strand transfer inhibitor mutations were identified. Sub-subtype A6 caused most of the infections (713/812; 87.8%) in all three countries, including in MSM. In contrast to earlier studies, no clear clusters related to the route of transmission were identified, indicating that, within the region, the exchange of viruses among the different risk groups may occur more often than earlier reported.
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Affiliation(s)
| | - Anastasiia Antonova
- T-Lymphotropic Viruses Laboratory, Gamaleya Centre of Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Giulia Di Teodoro
- EuResist Network, 00152 Rome, Italy
- Department of Computer Control and Management Engineering Antonio Ruberti, Sapienza University of Rome, 00185 Rome, Italy
| | - Rafael Ceña Diez
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, 14152 Stockholm, Sweden
| | - Nikoloz Chkhartishvili
- Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC), 0160 Tbilisi, Georgia
| | - Eva Heger
- Institute of Virology, University of Cologne, 50935 Cologne, Germany
| | - Anna Kuznetsova
- T-Lymphotropic Viruses Laboratory, Gamaleya Centre of Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Aleksey Lebedev
- T-Lymphotropic Viruses Laboratory, Gamaleya Centre of Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Aswathy Narayanan
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, 14152 Stockholm, Sweden
| | - Ekaterina Ozhmegova
- T-Lymphotropic Viruses Laboratory, Gamaleya Centre of Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Alexander Pronin
- Moscow Regional Center for Control and Prevention of AIDS and Infectious Diseases, 123098 Moscow, Russia
| | - Andrey Shemshura
- Clinical Center of HIV/AIDS of the Ministry of Health of Krasnodar Region, 350015 Krasnodar, Russia
| | - Alexandr Tumanov
- T-Lymphotropic Viruses Laboratory, Gamaleya Centre of Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Nico Pfeifer
- Methods in Medical Informatics, Department of Computer Science, University of Tübingen, 72076 Tübingen, Germany
| | - Rolf Kaiser
- Institute of Virology, University of Cologne, 50935 Cologne, Germany
| | - Francesco Saladini
- Department of Medical Biotechnology, University of Siena, 53100 Siena, Italy
| | - Maurizio Zazzi
- Department of Medical Biotechnology, University of Siena, 53100 Siena, Italy
| | | | - Marina Bobkova
- T-Lymphotropic Viruses Laboratory, Gamaleya Centre of Epidemiology and Microbiology, 123098 Moscow, Russia
- Correspondence: (M.B.); (A.S.)
| | - Anders Sönnerborg
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, 14152 Stockholm, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
- Correspondence: (M.B.); (A.S.)
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Kuznetsova A, Lebedev A, Gromov K, Kazennova E, Zazzi M, Incardona F, Sönnerborg A, Bobkova M. Pre-existing singleton E138A mutations in the reverse transcriptase gene do not affect the efficacy of first-line antiretroviral therapy regimens using rilpivirine in human immunodeficiency virus-infected patients. Clin Case Rep 2022; 10:e05373. [PMID: 35140966 PMCID: PMC8813671 DOI: 10.1002/ccr3.5373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/15/2021] [Accepted: 01/19/2022] [Indexed: 11/09/2022] Open
Abstract
General consensus suggests that even singleton E138A mutations in HIV reverse transcriptase at baseline are associated with resistance to rilpivirine (RPV). We detected 11 pre-existing E138A carriers treated with RPV in the pan European EuResist database. However, all 11 patients presented with full virological efficacy for first-line RPV-based ART regimens.
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Affiliation(s)
- Anna Kuznetsova
- Gamaleya Centre for epidemiology and microbiologyMoscowRussia
| | - Aleksey Lebedev
- Gamaleya Centre for epidemiology and microbiologyMoscowRussia
| | | | - Elena Kazennova
- Gamaleya Centre for epidemiology and microbiologyMoscowRussia
| | | | | | | | - Marina Bobkova
- Gamaleya Centre for epidemiology and microbiologyMoscowRussia
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Kirichenko A, Kireev D, Lopatukhin A, Murzakova A, Lapovok I, Saleeva D, Ladnaya N, Gadirova A, Ibrahimova S, Safarova A, Grigoryan T, Petrosyan A, Sarhatyan T, Gasich E, Bunas A, Glinskaya I, Yurovsky P, Nurov R, Soliev A, Ismatova L, Musabaev E, Kazakova E, Rakhimova V, Pokrovsky V. Prevalence of HIV-1 drug resistance in Eastern European and Central Asian countries. PLoS One 2022; 17:e0257731. [PMID: 35061671 PMCID: PMC8782385 DOI: 10.1371/journal.pone.0257731] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Eastern Europe and Central Asia (EECA) is one of the regions where the HIV epidemic continues to grow at a concerning rate. Antiretroviral therapy (ART) coverage in EECA countries has significantly increased during the last decade, which can lead to an increase in the risk of emergence, transmission, and spread of HIV variants with drug resistance (DR) that cannot be controlled. Because HIV genotyping cannot be performed in these countries, data about HIV DR are limited or unavailable. OBJECTIVES To monitor circulating HIV-1 genetic variants, assess the prevalence of HIV DR among patients starting antiretroviral therapy, and reveal potential transmission clusters among patients in six EECA countries: Armenia, Azerbaijan, Belarus, Russia, Tajikistan, and Uzbekistan. MATERIALS AND METHODS We analyzed 1071 HIV-1 pol-gene fragment sequences (2253-3369 bp) from patients who were initiating or reinitiating first-line ART in six EECA counties, i.e., Armenia (n = 120), Azerbaijan (n = 96), Belarus (n = 158), Russia (n = 465), Tajikistan (n = 54), and Uzbekistan (n = 178), between 2017 and 2019. HIV Pretreatment DR (PDR) and drug resistance mutation (DRM) prevalence was estimated using the Stanford HIV Resistance Database. The PDR level was interpreted according to the WHO standard PDR survey protocols. HIV-1 subtypes were determined using the Stanford HIV Resistance Database and subsequently confirmed by phylogenetic analysis. Transmission clusters were determined using Cluster Picker. RESULTS Analyses of HIV subtypes showed that EECA, in general, has the same HIV genetic variants of sub-subtype A6, CRF63_02A1, and subtype B, with different frequencies and representation for each country. The prevalence of PDR to any drug class was 2.8% in Uzbekistan, 4.2% in Azerbaijan, 4.5% in Russia, 9.2% in Armenia, 13.9% in Belarus, and 16.7% in Tajikistan. PDR to protease inhibitors (PIs) was not detected in any country. PDR to nucleoside reverse-transcriptase inhibitors (NRTIs) was not detected among patients in Azerbaijan, and was relatively low in other countries, with the highest prevalence in Tajikistan (5.6%). The prevalence of PDR to nonnucleoside reverse-transcriptase inhibitors (NNRTIs) was the lowest in Uzbekistan (2.8%) and reached 11.1% and 11.4% in Tajikistan and Belarus, respectively. Genetic transmission network analyses identified 226/1071 (21.1%) linked individuals, forming 93 transmission clusters mainly containing two or three sequences. We found that the time since HIV diagnosis in clustered patients was significantly shorter than that in unclustered patients (1.26 years vs 2.74 years). Additionally, the K103N/S mutation was mainly observed in clustered sequences (6.2% vs 2.8%). CONCLUSIONS Our study demonstrated different PDR prevalence rates and DR dynamics in six EECA countries, with worrying levels of PDR in Tajikistan and Belarus, where prevalence exceeded the 10% threshold recommended by the WHO for immediate public health action. Because DR testing for clinical purposes is not common in EECA, it is currently extremely important to conduct surveillance of HIV DR in EECA due to the increased ART coverage in this region.
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Affiliation(s)
- Alina Kirichenko
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | - Dmitry Kireev
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | - Alexey Lopatukhin
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | | | - Ilya Lapovok
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | - Daria Saleeva
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | - Natalya Ladnaya
- Central Research Institute of Epidemiology, Moscow, Russian Federation
| | | | | | - Aygun Safarova
- Republic Center of the Struggle against AIDS, Baku, Azerbaijan
| | | | | | | | - Elena Gasich
- Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus
| | - Anastasia Bunas
- Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus
| | - Iryna Glinskaya
- Republican Center for Hygiene, Epidemiology and Public Health, Minsk, Belarus
| | - Pavel Yurovsky
- Republican Center for Hygiene, Epidemiology and Public Health, Minsk, Belarus
| | - Rustam Nurov
- Republican AIDS prevention center, Dushanbe, Tajikistan
| | - Alijon Soliev
- Republican AIDS prevention center, Dushanbe, Tajikistan
| | | | | | | | - Visola Rakhimova
- Center for development of profession qualification of medical workers, Tashkent, Uzbekistan
| | - Vadim Pokrovsky
- Central Research Institute of Epidemiology, Moscow, Russian Federation
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Rudometova NB, Shcherbakova NS, Shcherbakov DN, Mishenova EV, Delgado E, Ilyichev AA, Karpenko LI, Thomson MM. Genetic Diversity and Drug Resistance Mutations in Reverse Transcriptase and Protease Genes of HIV-1 Isolates from Southwestern Siberia. AIDS Res Hum Retroviruses 2021; 37:716-723. [PMID: 33677988 DOI: 10.1089/aid.2020.0225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The analysis of a pol gene fragment encoding protease and part of reverse transcriptase was carried out for 55 sera collected in 2016 and 2018 from HIV-1-infected patients diagnosed in 2014-2018 living in the south of Western Siberia, Russia: Altai Territory (n = 11), Republic of Altai (n = 15), Kemerovo region (n = 18), and Novosibirsk region (n = 11). CRF63_02A was the dominant genetic form (>70%) in the Altai Territory and Kemerovo and Novosibirsk regions, with subsubtype A6 comprising <30% of samples. In the Altai Republic, subsubtype A6 was predominant (53%), with 33% of viruses belonging to CRF63_02A. Four CRF63_02A/A6 unique recombinant forms were identified in the Altai Territory, Kemerovo Region, and the Altai Republic. A majority (11 of 15) of CRF63_02A viruses from Kemerovo were grouped in a cluster. Antiretroviral (ARV) drug resistance mutations were found in 6 (14%) of 43 drug-naive patients. This study provides new insights in HIV-1 molecular epidemiology and prevalence of transmitted ARV drug resistance mutations in Southwestern Siberia.
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Affiliation(s)
- Nadezhda B. Rudometova
- Department of Bioengineering, State Research Center of Virology and Biotechnology “Vector”, Koltsovo, Russia
| | - Nadezhda S. Shcherbakova
- Department of Bioengineering, State Research Center of Virology and Biotechnology “Vector”, Koltsovo, Russia
| | - Dmitry N. Shcherbakov
- Department of Bioengineering, State Research Center of Virology and Biotechnology “Vector”, Koltsovo, Russia
| | - Elena V. Mishenova
- Budgetary Health Care Institution of the Republic of Altai “Center for the Prevention and Control of AIDS”, Gorno-Altaysk, Russia
| | - Elena Delgado
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Alexander A. Ilyichev
- Department of Bioengineering, State Research Center of Virology and Biotechnology “Vector”, Koltsovo, Russia
| | - Larisa I. Karpenko
- Department of Bioengineering, State Research Center of Virology and Biotechnology “Vector”, Koltsovo, Russia
| | - Michael M. Thomson
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
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