Impact of the war in Ukraine on HIV-1 subtype distribution and antiretroviral resistance in Slovakia, 2022.

The study analyses the prevalence of HIV-1 subtypes and antiretroviral resistance among newly registered HIV-positive individuals in Slovakia in 2022, with a particular focus on the impact of migration caused by the war in Ukraine. A total of 198 cases were confirmed or reconfirmed HIV-positive of whom 109 (55.1%) citizens were from Ukraine, 80 (40.4%) were from Slovakia, and 9 (4.5%) were from other countries. HIV subtyping and resistance testing were performed in 99 patients (50.0% of all newly registered cases). Among 99 analysed patients, HIV-1 subtype B was detected in 51 (51.5%) and non-B subtypes in 48 (48.5%), with subtype A6 being the most frequent non-B variant (38.4%). Non-B variants were more common in Ukrainians (28/31; 90.3%) than in Slovaks (17/66; 25.8%). The Ukrainian subgroup was not fully representative, as most cases were reconfirmations of previously diagnosed and treated patients. Minor resistance-associated mutations were observed in 9 (9.1%) of patients, while one additional previously treated Ukrainian patient harboured the major resistance mutation M184I. The findings demonstrate changes in the molecular profile of newly registered HIV cases in Slovakia in 2022, mainly associated with migration from Ukraine. Genetic diversity of circulating HIV-1 strains has increased mainly by introduction of subtype A6 and other non-B variants. This fact emphasises the need for continuous molecular surveillance and tailored therapeutic approaches for HIV infection in Central Europe.