The Genetic Variability of HIV-1 in Kyrgyzstan: The Spread of CRF02_AG and Subtype A1 Recombinants

To evaluate HIV-1 variability and drug resistance, a cross-sectional study involving 57 naïve patients was carried out in Kyrgyzstan, Central Asia, between 2009 and 2010. Most of the patients were men (77.2%), and most of them were injecting drug users (97.7%). To analyze the HIV-1 genetic variability, DNA sequencing in both the PR-RT and gag genome regions was performed. The study identified complex HIV-1 molecular epidemiological patterns in Kyrgyzstan with the co-circulation of multiple subtypes, including currently circulating and unique recombinant forms. CRF02_AG was the predominant genetic form (45.6%; 26/57), and the second-most prevalent HIV-1 genetic variant was subtype A1 (IDU-A) (40.4%; 23/57). The phylogenetic analysis results indicate a link between the HIV epidemic in Kyrgyzstan and Russia and Ukraine on the one hand and other Central Asian FSU countries on the other hand. The simultaneous analysis of pol and gag regions allowed the identification of seven unique recombinant forms (12.3%) formed by two major variants (CRF02_AG/A1), each having a specific PR-RT structure. The analysis of drug resistance mutations found NRTI mutations M184I and K65R and NNRTI mutations Y181C, K103N, and G190S in four sequences; no mutations in the PR region were detected. The representativeness of this study was limited both in terms of collection size and in terms of the incomplete representation of different population groups. Further studies are needed to better understand the evolution of HIV-1 genetic variants and drug resistance in Kyrgyzstan and Central Asia.