Liulchuk M. Drug Resistance monitoring in the HIV surveillance system in Ukraine

This thesis is dedicated to aid an important scientific and research purpose of public health in Ukraine – to improve HIV surveillance system. For the first time a comprehensive molecular genetics analysis of the HIV population circulating at the current stage of the HIV/AIDS epidemic in Ukraine was conducted. It was determined that the level of transmitted drug resistance (TDR) to antiretroviral therapy (ART) remains low across regions of Ukraine. The frequency of acquired drug resistance (ADR) to ART in adult HIV-infected patients was estimated at 6.0%. HIV drug resistance mutations occur statistically significantly more frequently in male patients, compared to female, which is attributed to bio-behavioral gender differences. ART genetic barrier was recognized to be an important factor: the higher the genetic barrier is, the lower the risk of HIV resistance-associated mutations (RAMs) arising. Emergence of RAMs to ART drugs that act as Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) and Protease Inhibitors (PI) occurs significantly less often in children compared to adults (p <0.05). This can be attributed to the fact that most children start ART with a regimen that includes PI drugs with high genetic barrier. Annual monitoring of Early Warning Indicators (EWI) is a crucial element of HIV Drug resistance surveillance as it allows to determine the effect of various factors on the risk of drugs resistance arisal. National strategy for HIV-drug resistance monitoring in Ukraine was developed based on the research of the TDR and ADR spread and factors that affect it.