{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T12:21:40Z","timestamp":1781094100688,"version":"3.54.1"},"reference-count":34,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,10]],"date-time":"2025-05-10T00:00:00Z","timestamp":1746835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Nazarbayev University","award":["20122022CRP1605"],"award-info":[{"award-number":["20122022CRP1605"]}]},{"name":"Nazarbayev University","award":["#D43TW012507"],"award-info":[{"award-number":["#D43TW012507"]}]},{"name":"U.S. National Institutes of Health","award":["20122022CRP1605"],"award-info":[{"award-number":["20122022CRP1605"]}]},{"name":"U.S. National Institutes of Health","award":["#D43TW012507"],"award-info":[{"award-number":["#D43TW012507"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>The number of people living with HIV in Kazakhstan increased from 11,000 to 35,000 between 2010 and 2021, with emerging antiretroviral therapy (ART) resistance posing a challenge to effective treatment. Unsafe injection practices among people who inject drugs (PWID), the stigma against men who have sex with men, sex work, drug possession, HIV transmission, HIV exposure, and the non-disclosure of HIV status create obstacles to effective prevention and care. Our recent studies with people living with HIV (PLWH) in Kazakhstan have revealed the prevalence of mutations in HIV that may confer resistance to certain ART components currently being administered in the country. Additionally, subtype A6- and CRF02_AG-infected PLWH displayed the occurrence of certain distinct subtype-specific DRMs. Subtype A6 exhibited a tendency for the DRMs A62V, G190S, K101E, D67N, and V77I, whereas CRF02_AG was more associated with S162A, K103N, and V179E. Both subtypes had a comparable frequency of the M184V mutation and displayed similar patterns in the distribution of Q174K. Based on our findings, we recommend that DRM screening and subtype diagnosis before the initiation of ART will improve treatment efficiency while preventing the emergence of further DRMs in Kazakhstan.<\/jats:p>","DOI":"10.3390\/v17050690","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T03:59:26Z","timestamp":1747108766000},"page":"690","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Need for the Optimization of HIV Antiretroviral Therapy in Kazakhstan"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4203-4598","authenticated-orcid":false,"given":"Aidana","family":"Mustafa","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalya","family":"Dzissyuk","sequence":"additional","affiliation":[{"name":"Kazakh Scientific Center of Dermatology and Infectious Diseases, Almaty 050094, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bauyrzhan","family":"Bayserkin","sequence":"additional","affiliation":[{"name":"Kazakh Scientific Center of Dermatology and Infectious Diseases, Almaty 050094, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinara","family":"Begimbetova","sequence":"additional","affiliation":[{"name":"Laboratory of Molecular Oncology, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhamilya","family":"Nugmanova","sequence":"additional","affiliation":[{"name":"HIV Infection and Infection Control Division, Department of Epidemiology, Asfendiyarov Kazakh National Medical University, Almaty 050094, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,10]]},"reference":[{"key":"ref_1","unstructured":"(2023, October 31). UNAIDS 2023 Report. UNAIDS\u2014Global Report 2023. Available online: https:\/\/thepath.unaids.org\/."},{"key":"ref_2","unstructured":"(2025, January 24). Data for Kazakhstan, Uzbekistan, Turkmenistan, Tajikistan, Kyrgyz Republic | Data. Available online: https:\/\/data.worldbank.org\/?locations=KZ-UZ-TM-TJ-KG."},{"key":"ref_3","unstructured":"(2023, November 03). UNAIDS Data 2022. Available online: https:\/\/www.unaids.org\/en\/resources\/documents\/2023\/2022_unaids_data."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"387","DOI":"10.2147\/HIV.S413876","article-title":"Prevalence of HIV in Kazakhstan 2010\u20132020 and Its Forecasting for the Next 10 Years","volume":"15","author":"Mussina","year":"2023","journal-title":"HIV\/AIDS Res. Palliat. Care"},{"key":"ref_5","unstructured":"(2025, March 27). Kazakh Scientific Centre of Dermatology and Infectious Diseases | News | More than 90 Percent of People Living with HIV in the Country have Suppressed Viral Load. Available online: https:\/\/kncdiz.kz\/en\/news\/item\/8999\/."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Sanaubarova, A., Pujol-Hodge, E., Dzissyuk, N., Lemey, P., Vermund, S.H., Leigh Brown, A.J., and Ali, S. (2023). High-Level Drug-Resistant Mutations among HIV-1 Subtype A6 and CRF02_AG in Kazakhstan. Viruses, 15.","DOI":"10.3390\/v15071407"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Mukhatayeva, A., Mustafa, A., Dzissyuk, N., Issanov, A., Mukhatayev, Z., Bayserkin, B., Vermund, S.H., and Ali, S. (2022). Antiretroviral Therapy Resistance Mutations among HIV Infected People in Kazakhstan. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-22163-7"},{"key":"ref_8","unstructured":"(2023, November 03). \u0412\u0418\u0427-\u0438\u043d\u0444\u0435\u043a\u0446\u0438\u044f \u0443 \u0432\u0437\u0440o\u0441\u043b\u044b\u0445 > \u041a\u043b\u0438\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u043f\u0440o\u0442o\u043ao\u043b\u044b \u041c\u0417 \u0420\u041a\u20142023 (\u041a\u0430\u0437\u0430\u0445\u0441\u0442\u0430\u043d) > MedElement. Available online: https:\/\/diseases.medelement.com\/disease\/%D0%B2%D0%B8%D1%87-%D0%B8%D0%BD%D1%84%D0%B5%D0%BA%D1%86%D0%B8%D1%8F-%D1%83-%D0%B2%D0%B7%D1%80%D0%BE%D1%81%D0%BB%D1%8B%D1%85-%D0%BA%D0%BF-%D1%80%D0%BA-2023\/17597."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.1097\/QAD.0000000000000082","article-title":"Predicted Levels of HIV Drug Resistance: Potential Impact of Expanding Diagnosis, Retention, and Eligibility Criteria for Antiretroviral Therapy Initiation","volume":"28","author":"Cambiano","year":"2014","journal-title":"AIDS"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.meegid.2016.08.031","article-title":"HIV-1 Drug Resistance and Resistance Testing","volume":"46","author":"Clutter","year":"2016","journal-title":"Infect Genet. Evol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1056\/NEJMra025195","article-title":"HIV Drug Resistance","volume":"350","author":"Clavel","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1089\/aid.2013.0291","article-title":"Short Communication: Molecular Epidemiology of HIV Type 1 Infection in Kazakhstan: CRF02_AG Prevalence Is Increasing in the Southeastern Provinces","volume":"30","author":"Lapovok","year":"2014","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_13","unstructured":"PEPFAR (2025, March 27). Central Asia Operational Plan 2020 Strategic Direction Summary. Available online: https:\/\/sustainability.unaids.org\/country\/tajikistan\/."},{"key":"ref_14","unstructured":"(2023, December 06). BBS-MSM-2021-OnePager-2-1.Pdf. Available online: https:\/\/sustainability.unaids.org\/country\/kyrgyzstan\/."},{"key":"ref_15","unstructured":"(2023, December 06). UKR_2020_countryreport.Pdf. Available online: https:\/\/sustainability.unaids.org\/country\/ukraine\/."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"20798","DOI":"10.7448\/IAS.19.1.20798","article-title":"Treatment Failure and Drug Resistance in HIV-Positive Patients on Tenofovir-Based First-Line Antiretroviral Therapy in Western Kenya","volume":"19","author":"Brooks","year":"2016","journal-title":"J. Int. AIDS Soc."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"(2025, January 24). Cost-Effectiveness of Tenofovir as First-Line Antiretroviral Therapy in India | Clinical Infectious Diseases | Oxford Academic. Available online: https:\/\/academic.oup.com\/cid\/article\/50\/3\/416\/397138?login=true.","DOI":"10.1086\/649884"},{"key":"ref_18","unstructured":"(2025, January 24). Medicine. Available online: https:\/\/journals.lww.com\/md-journal\/fulltext\/2018\/12140\/adherence,_virological_outcome,_and_drug.54.aspx."},{"key":"ref_19","unstructured":"(2025, March 27). Women Help Women Overcome HIV Stigma in Kazakhstan, with ICAP\u2019s Support. Available online: https:\/\/icap.columbia.edu\/news-events\/women-help-women-to-overcome-hiv-stigma-in-kazakhstan-with-icaps-support\/."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1080\/09540121.2024.2414078","article-title":"A Qualitative Dyad Analysis of Barriers and Facilitators of Antiretroviral Therapy (ART) Adherence among People Who Inject Drugs (PWID) with HIV in Kazakhstan","volume":"37","author":"Neuenschwander","year":"2025","journal-title":"AIDS Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"167","DOI":"10.2174\/187152611795589663","article-title":"HIV Treatment Adherence, Drug Resistance, Virologic Failure: Evolving Concepts","volume":"11","author":"Nachega","year":"2011","journal-title":"Infect. Disord. Drug Targets Disord."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2602","DOI":"10.1128\/AAC.39.12.2602","article-title":"L-743, 726 (DMP-266): A Novel, Highly Potent Nonnucleoside Inhibitor of the Human Immunodeficiency Virus Type 1 Reverse Transcriptase","volume":"39","author":"Young","year":"1995","journal-title":"Antimicrob. Agents Chemoth."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"41","DOI":"10.2165\/00003088-199936010-00004","article-title":"Clinical Pharmacokinetics of Lamivudine","volume":"36","author":"Johnson","year":"1999","journal-title":"Clin. Pharmacokinet."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"595","DOI":"10.2165\/00003088-200443090-00003","article-title":"Tenofovir Disoproxil Fumarate: Clinical Pharmacology and Pharmacokinetics","volume":"43","author":"Kearney","year":"2004","journal-title":"Clin. Pharmacokinet."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/S1473-3099(11)70032-9","article-title":"EuroCoord-CHAIN study group. Effect of Transmitted Drug Resistance on Virological and Immunological Response to Initial Combination Antiretroviral Therapy for HIV (EuroCoord-CHAIN Joint Project): A European Multicohort Study","volume":"11","author":"Wittkop","year":"2011","journal-title":"Lancet Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1086\/644505","article-title":"Transmission of Drug-Resistant HIV-1 Is Stabilizing in Europe","volume":"200","author":"Vercauteren","year":"2009","journal-title":"J. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1097\/QAD.0b013e3283388742","article-title":"Prevalence of Transmitted Drug Resistance Associated Mutations and HIV-1 Subtypes in New HIV-1 Diagnoses, U.S.-2006","volume":"24","author":"Wheeler","year":"2010","journal-title":"AIDS"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/S0140-6736(05)71139-9","article-title":"Infection with Multidrug Resistant, Dual-Tropic HIV-1 and Rapid Progression to AIDS: A Case Report","volume":"365","author":"Markowitz","year":"2005","journal-title":"Lancet"},{"key":"ref_29","first-page":"165","article-title":"HIV-1 Resistance to First- and Second-Generation Non-Nucleoside Reverse Transcriptase Inhibitors","volume":"11","author":"Ghosn","year":"2009","journal-title":"AIDS Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1517\/17460441.3.7.775","article-title":"Second Generation HIV Protease Inhibitors against Resistant Virus","volume":"3","author":"Lu","year":"2008","journal-title":"Expert. Opin. Drug Discov."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"9701920","DOI":"10.1155\/2020\/9701920","article-title":"Transmission of HIV and HCV within Former Soviet Union Countries","volume":"2020","author":"Aibekova","year":"2020","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Aibekova, L., Foley, B., Hortelano, G., Raees, M., Abdraimov, S., Toichuev, R., and Ali, S. (2018). Molecular Epidemiology of HIV-1 Subtype A in Former Soviet Union Countries. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0191891"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/j.ijid.2020.12.068","article-title":"Prevalence of HIV, HCV and HBV in Central Asia and the Caucasus: A Systematic Review","volume":"104","author":"Davlidova","year":"2021","journal-title":"Int. J. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"105402","DOI":"10.1016\/j.meegid.2022.105402","article-title":"Origin and Evolution of Subtype B Variants in the Former Soviet Union Countries","volume":"108","author":"Mustafa","year":"2023","journal-title":"Infect. Genet. Evol."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/5\/690\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:30:36Z","timestamp":1760031036000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/5\/690"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,10]]},"references-count":34,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["v17050690"],"URL":"https:\/\/doi.org\/10.3390\/v17050690","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,10]]}}}