Maarten A.A. van de Klundert 1, Anastasiia Antonova 2, Giulia Di Teodoro 3,4, Rafael Ceña Diez 1, Nikoloz Chkhartishvili 5, Eva Heger 6, Anna Kuznetsova 2, Aleksey Lebedev 2, Aswathy Narayanan 1, Ekaterina Ozhme-gova 2, Alexander Pronin 7, Andrey Shemshura 8, Alexander Tumanov 2, Rolf Kaiser 6, Francesco Saladini 9, Mau-rizio Zazzi 9, Francesca Incardona 3,10, Marina Bobkova 2, Anders Sönnerborg 1,11,

Affiliates

1 Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Swe-den; maarten.van.de.klundert@ki.se (M.A.A.vdK); aswathy.narayanan@ki.se (A.N.); rafael.cena.diez@ki.se (R.C.D.); anders.sonnerborg@ki.se (A.S.). 2 T-lymphotropic viruses laboratory, Gamaleya centre of epidemiology and microbiology, Moscow, Russia; anastaseika95@mail.ru (A.A.); a-myznikova@list.ru (A.K.); lebedevalesha236@gmail.com (A.L.); belokopy-tova.01@mail.ru (E.O.); desep@mail.ru (A.T.); mrbobkova@mail.ru (M.B.). 3 EuResist Network, Italy; giuliaditeodoro@gmail.com (G.dT); f.incardona@informa.pro (F.I.). 4 Department of Computer Control and Management Engineering Antonio Ruberti, Sapienza University of Rome, Rome, Italy 5 Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC), Tbilisi, Georgia; nc@aidscenter.ge (N.C.). 6 Institute of Virology, University of Cologne, 50935 Cologne, Germany; eva.heger@uk-koeln.de (E.H.) rolf.kaiser@uk-koeln.de (R.K.). 7 Moscow Regional Center for Control and Prevention of AIDS and Infectious Diseases, Moscow, Russia; proninalexander@yandex.ru (A.P.) 8 Clinical Center of HIV/AIDS of the Ministry of Health of Krasnodar Region, Krasnodar, Russia.; shemsh@mail.ru (A.S.) 9 Department of Medical Biotechnology, University of Siena, Siena, Italy; france.saladini@gmail.com (F.S), maurizio.zazzi@gmail.com (M.Z). 10 InformaPRO, Italy 11 Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; anders.sonnerborg@ki.se (A.S.).

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 initiation of antiretroviral therapy. In 190 Ukrainian patients, the integrase sequence was also determined. The most reported route of transmission was heterosexual, 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 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 exchange of viruses among the different risk groups is common.