Current status of HIV-1 diversity and drug resistance monitoring in the former USSR.

This review summarizes the available data on the molecular epidemiology of HIV and the transmission of HIV drug resistance in the former USSR (FSU) in recent decades. The data presented here were obtained from publications or personal communication with colleagues in these countries as well as from studies the author was involved in. The molecular epidemiology data demonstrate the preservation of a relatively low diversity of HIV-1 in FSU countries, where infections are predominantly caused by subtype A, IDU-A variant. Subtype B was the second most common variant, followed by CRF03_AB and CRF02_AG, with CRF02_AG spreading rapidly in Central Asian countries and the Asian part of Russia. Mosaic variants formed from CRF02_AG and IDU-A were found elsewhere, as were subtypes C, G, and CRF01_AE. The status of HIV drug resistance monitoring in FSU countries is cause for serious concern because, so far, no regular action has been undertaken. HIV genotyping has been available in Russia for several years and is becoming accessible to patients in Belarus, Ukraine, Kazakhstan, and Uzbekistan. Nevertheless, this subject has not been systematically studied, and no data have been presented to the scientific community. Several recent studies suggest a low level of HIV drug resistance transmission in the FSU (3-7%); however, problems with irregular drug supply and possible low adherence may lead to the rapid growth of these figures. These findings support the urgent need to develop a shared HIV drug resistance monitoring system for FSU countries to better control the HIV epidemic in the region.