CURRENT MONITORING DATA ON THE DEVELOPMENT OF HIV-1 RESISTANCE IN RESIDENTS WITH HIV INFECTION IN THE TOMSK REGION

The paper presents the results of a molecular epidemiological study on HIV-1 infection in the Tomsk region. The goal of the study was to investigate development and spread of resistant strains of HIV-1 to antiretroviral drugs. It has been found that the genetic variant CRF63_02A6 of HIV-1 continues to dominate, accounting for 75% of all samples. Subtype A6 is present in about 15%, and unique recombinant forms occur in 10%. Transmission of primary resistant strains occurs in 9.5%, and HIV1 carrying the K103N mutation, which causes high resistance to nevirapine and efavirenz, is registered in half of these cases. When antiretroviral treatment is ineffective, resistant strains develop in 78%, and resistance to both nucleoside and non-nucleoside reverse transcriptase inhibitors (NRTIs and NNRTIs) is observed in 53%. The M184V/I mutation, responsible for resistance to lamivudine and emtricitabine, is the most common among NRTI mutations, accounting for 65.6% of cases. Incidence of other HIV mutations that are resistant to NIOTs does not exceed 10%. Among mutations to NNRTIs, the K103N mutation was found in 28% of cases, and the V106I mutation, which is the main resistance mutation to elsulfavirine (ESV), was detected more often. There are also other substitutions associated with a decrease in sensitivity to ESV, including mutations in codons E138, Y181, A98, Y188, L100, M230, and F227. HIV-1 with reduced sensitivity to AI was isolated from 13% of patients with virological failure of ART. It is important to note that some patients showed significant resistance to bictegravir and dolutegravir, which is a negative prognostic factor. In 18% of cases, HIV-1 was resistant to 2-4 classes of ART medications, and these viruses were isolated from patients with viral loads ranging from 200,000 to 2 million RNA copies/ml. The obtained results emphasize the need to expand access to HIV resistance testing for people living with HIV and importance of antiretroviral therapy (ART) efficiency surveillance.

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