{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T15:41:55Z","timestamp":1789659715852,"version":"4.0.1"},"reference-count":195,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>The molecular epidemiology and antiretroviral (ARV) drug resistance of human immunodeficiency virus type 1 (HIV-1) remain incompletely outlined in the Middle East and North Africa (MENA). The aim of this retrospective molecular epidemiology study was to analyze MENA HIV-1 sequences for phylogenetic clustering and to delineate surveillance drug-resistance mutations (SDRMs) for nucleoside reverse-transcriptase inhibitors (NRTIs), non-nucleoside reverse-transcriptase inhibitors (NNRTIs), and protease inhibitors (PIs) across various periods, locations, and subtypes\/circulating recombinant forms (CRFs). Viral sequences were retrieved from the Los Alamos HIV Sequence Database as of 15 April 2026. Analyses were done using multiple sub-gene regions (two env regions (n = 224 and n = 60) and PR (n = 2413) and RT (n = 2103) of the pol gene). Phylogeny construction was conducted using maximum-likelihood estimation, while ARV drug resistance analysis was conducted using the Stanford HIVdb algorithm. The HIV-1 MENA sequences showed a remarkable genetic diversity, with co-circulation of multiple subtypes\/CRFs, including subtype B in the Maghreb, Levant, and Egypt sub-regions, subtypes A1, G, CRF01_AE, and CRF02_AG in the Gulf Cooperation Council (GCC) and Yemen sub-region, and subtypes C and D in the Horn of Africa and Sudan sub-region. The percentage of MENA HIV-1 sequences in clusters was 10.3% for env1, 8.3% for env2, 22.0% for PR and 37.2% for RT. Phylogenetic reconstruction hinted at a structured epidemic dominated by small transmission units, with most clusters comprising dyads (n = 260) or networks (n = 142) and a limited number of large clusters (n = 8) that were largely confined within national boundaries, with only occasional cross-border linkages (n = 8). Overall SDRM prevalence was 3.2% in the PR region and 14.9% in the RT region, with a higher percentage of NNRTI-associated mutations (10.0%) than NRTI-associated mutations (9.1%) and dual-class resistance observed in 4.1% of sequences. Phylogenetic clustering was not associated with the probability of harboring SDRMs; however, negative binomial models showed that non-clustered sequences had a greater burden of NRTI-associated mutations, whereas no such association was observed for NNRTI- or PI-associated mutations. The findings showed predominantly localized and fragmented MENA HIV-1 transmission dynamics. Heterogeneous ARV drug resistance dynamics indicated that resistance emergence might be shaped by broader epidemiologic and treatment-related factors rather than ongoing clustered transmission. There is a need for coordinated molecular surveillance and optimized ART strategies across the MENA countries.<\/jats:p>","DOI":"10.3390\/v18080897","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T13:12:56Z","timestamp":1786713176000},"page":"897","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Phylogenetic Evidence of Local HIV-1 Transmission and Antiretroviral Drug Resistance in the Middle East and North Africa"],"prefix":"10.3390","volume":"18","author":[{"given":"Esraa","family":"Al-Fraihat","sequence":"first","affiliation":[{"name":"Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan"},{"name":"Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal","family":"Irshaid","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3273-524X","authenticated-orcid":false,"given":"Mohammed","family":"Sallam","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Mediclinic Parkview Hospital, Mediclinic Middle East, Dubai P.O. Box 505004, United Arab Emirates"},{"name":"Department of Management, Mediclinic Parkview Hospital, Mediclinic Middle East, Dubai P.O. Box 505004, United Arab Emirates"},{"name":"College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai P.O. Box 505055, United Arab Emirates"},{"name":"Department of Management, School of Business, International American University, Los Angeles, CA 90010, USA"},{"name":"Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain P.O. Box 17666, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8276-341X","authenticated-orcid":false,"given":"Johan","family":"Snygg","sequence":"additional","affiliation":[{"name":"College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai P.O. Box 505055, United Arab Emirates"},{"name":"Department of Management, Mediclinic City Hospital, Mediclinic Middle East, Dubai P.O. Box 505004, United Arab Emirates"},{"name":"Department of Anesthesia and Intensive Care, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasha","family":"Awawdeh","sequence":"additional","affiliation":[{"name":"College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai P.O. Box 505055, United Arab Emirates"},{"name":"Department of Internal Medicine, Mediclinic Parkview Hospital, Mediclinic Middle East, Dubai P.O. Box 505004, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasanain","family":"Al-Shakerchi","sequence":"additional","affiliation":[{"name":"College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai P.O. Box 505055, United Arab Emirates"},{"name":"Department of Internal Medicine, Mediclinic Parkview Hospital, Mediclinic Middle East, Dubai P.O. Box 505004, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sama","family":"Al-Baidhani","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0165-9670","authenticated-orcid":false,"given":"Malik","family":"Sallam","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan"},{"name":"Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"ref_1","unstructured":"UNAIDS (2026, April 19). Middle East and North Africa\u2014Regional Profile\u20142025 Global AIDS Update\u2014AIDS, Crisis and the Power to Transform. Available online: https:\/\/www.unaids.org\/en\/resources\/documents\/2025\/2025-global-aids-update-mena."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Chemaitelly, H., Weiss, H.A., Calvert, C., Harfouche, M., and Abu-Raddad, L.J. (2019). HIV epidemiology among female sex workers and their clients in the Middle East and North Africa: Systematic review, meta-analyses, and meta-regressions. BMC Med., 17.","DOI":"10.1186\/s12916-019-1349-y"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e496","DOI":"10.1016\/S2352-3018(22)00100-X","article-title":"HIV incidence and impact of interventions among female sex workers and their clients in the Middle East and north Africa: A modelling study","volume":"9","author":"Chemaitelly","year":"2022","journal-title":"Lancet HIV"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Mumtaz, G., Hilmi, N., McFarland, W., Kaplan, R.L., Akala, F.A., Semini, I., Riedner, G., Tawil, O., Wilson, D., and Abu-Raddad, L.J. (2010). Are HIV epidemics among men who have sex with men emerging in the Middle East and North Africa?: A systematic review and data synthesis. PLoS Med., 8.","DOI":"10.1371\/journal.pmed.1000444"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e72","DOI":"10.1016\/S2352-3018(25)00236-X","article-title":"MSM and HIV in the Middle East and north Africa","volume":"13","year":"2026","journal-title":"Lancet HIV"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Mumtaz, G.R., Weiss, H.A., Thomas, S.L., Riome, S., Setayesh, H., Riedner, G., Semini, I., Tawil, O., Akala, F.A., and Wilson, D. (2014). HIV among people who inject drugs in the Middle East and North Africa: Systematic review and data synthesis. PLoS Med., 11.","DOI":"10.1596\/23199"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"20873","DOI":"10.7448\/IAS.19.1.20873","article-title":"Status of HIV and hepatitis C virus infections among prisoners in the Middle East and North Africa: Review and synthesis","volume":"19","author":"Heijnen","year":"2016","journal-title":"J. Int. AIDS Soc."},{"key":"ref_8","unstructured":"GBD 2021 HIV Collaborators (2024). Global, regional, and national burden of HIV\/AIDS, 1990\u20132021, and forecasts to 2050, for 204 countries and territories: The Global Burden of Disease Study 2021. Lancet HIV, 11, e807\u2013e822."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Sallam, M., Al-Khatib, A.O., Sabra, T., Al-Baidhani, S., Al-Mahzoum, K., Aleigailly, M.A., and Sallam, M. (2025). Challenges in Elucidating HIV-1 Genetic Diversity in the Middle East and North Africa: A Review Based on a Systematic Search. Viruses, 17.","DOI":"10.3390\/v17030336"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"18962","DOI":"10.7448\/IAS.17.1.18962","article-title":"HIV case reporting in the countries of North Africa and the Middle East","volume":"17","author":"Bozicevic","year":"2014","journal-title":"J. Int. AIDS Soc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"13859","DOI":"10.1038\/s41598-023-40743-z","article-title":"Trends and projection of incidence, mortality, and disability-adjusted life years of HIV in the Middle East and North Africa (1990\u20132030)","volume":"13","author":"Khorrami","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Montaner, J.S., Lima, V.D., Harrigan, P.R., Louren\u00e7o, L., Yip, B., Nosyk, B., Wood, E., Kerr, T., Shannon, K., and Moore, D. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV\/AIDS morbidity, mortality and HIV transmission: The \u201cHIV Treatment as Prevention\u201d experience in a Canadian setting. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0087872"},{"key":"ref_13","first-page":"4117","article-title":"Quality of life of people living with HIV and AIDS and antiretroviral therapy","volume":"2012","author":"Oguntibeju","year":"2012","journal-title":"HIV AIDS"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Montaner, J.S.G., Lima, V.D., Salters, K.A., Toy, J., Joy, J.B., Guillemi, S., and Barrios, R. (2025). Generalized Treatment as Prevention Plus Focused Pre-Exposure Prophylaxis Is the Key to Controlling HIV\/AIDS. Trop. Med. Infect. Dis., 10.","DOI":"10.3390\/tropicalmed10030075"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"(2017). Antiretroviral Therapy Cohort Collaboration. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: A collaborative analysis of cohort studies. Lancet HIV, 4, e349\u2013e356.","DOI":"10.1016\/S2352-3018(17)30066-8"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Karbasi, A., Fordjuoh, J., Abbas, M., Iloegbu, C., Patena, J., Adenikinju, D., Vieira, D., Gyamfi, J., and Peprah, E. (2023). An Evolving HIV Epidemic in the Middle East and North Africa (MENA) Region: A Scoping Review. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20053844"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1016\/S0140-6736(13)61998-4","article-title":"Antiretroviral treatment of HIV-1 prevents transmission of HIV-1: Where do we go from here?","volume":"382","author":"Cohen","year":"2013","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Berghuis, A., Matlashewski, G., Wainberg, M.A., Sheppard, D., and Gotte, M. (2017). Transmission of HIV-1 Drug Resistance. Handbook of Antimicrobial Resistance, Springer.","DOI":"10.1007\/978-1-4939-0694-9"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.ijid.2015.11.008","article-title":"HIV\/AIDS: Trends in the Middle East and North Africa region","volume":"44","author":"Doroudi","year":"2016","journal-title":"Int. J. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S83","DOI":"10.1097\/QAI.0b013e3181aafd3f","article-title":"HIV surveillance and epidemic profile in the Middle East and North Africa","volume":"51","author":"Shawky","year":"2009","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"iii11","DOI":"10.1136\/sextrans-2012-050849","article-title":"HIV surveillance in MENA: Recent developments and results","volume":"89","author":"Bozicevic","year":"2013","journal-title":"Sex. Transm. Infect."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/COH.0000000000000038","article-title":"The emerging face of the HIV epidemic in the Middle East and North Africa","volume":"9","author":"Mumtaz","year":"2014","journal-title":"Curr. Opin. HIV AIDS"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"iii5","DOI":"10.1136\/sextrans-2012-050888","article-title":"Characterising the progress in HIV\/AIDS research in the Middle East and North Africa","volume":"89","author":"Saba","year":"2013","journal-title":"Sex. Transm. Infect."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.ijid.2016.01.017","article-title":"HIV in the MENA Region: Cultural and Political Challenges","volume":"44","author":"Mokhbat","year":"2016","journal-title":"Int. J. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/01.aids.0000386728.49059.92","article-title":"HIV\/AIDS in the Middle East and North Africa: New study methods, results, and implications for prevention and care","volume":"24","author":"McFarland","year":"2010","journal-title":"Aids"},{"key":"ref_26","first-page":"83","article-title":"Is UNAIDS 90-90-90 target a Dream or a Reality for Middle East and North Africa Region on Ending the AIDS Epidemic? A Review Study","volume":"20","author":"Joulaei","year":"2018","journal-title":"AIDS Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/S0140-6736(08)61094-6","article-title":"Religious leaders key in the Middle East\u2019s HIV\/AIDS fight","volume":"372","author":"McGirk","year":"2008","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Alomair, N., and Alageel, S. (2025). Public\u2019s perceptions and attitudes toward HIV and people living with HIV in GCC countries: A qualitative study. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1718112"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Kteily-Hawa, R., Hawa, A.C., Gogolishvili, D., Al Akel, M., Andruszkiewicz, N., Vijayanathan, H., and Loutfy, M. (2022). Understanding the epidemiological HIV risk factors and underlying risk context for youth residing in or originating from the Middle East and North Africa (MENA) region: A scoping review of the literature. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0260935"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Sallam, M., Alabbadi, A.M., Abdel-Razeq, S., Battah, K., Malkawi, L., Al-Abbadi, M.A., and Mahafzah, A. (2022). HIV Knowledge and Stigmatizing Attitude towards People Living with HIV\/AIDS among Medical Students in Jordan. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19020745"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Aziz, M.M., Abdelrheem, S.S., and Mohammed, H.M. (2023). Stigma and discrimination against people living with HIV by health care providers in Egypt. BMC Health Serv. Res., 23.","DOI":"10.1186\/s12913-023-09676-1"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"184","DOI":"10.2989\/16085906.2025.2577374","article-title":"Assessment of HIV\/AIDS-related stigma and knowledge gaps among healthcare providers in Egypt","volume":"24","author":"Mansour","year":"2025","journal-title":"Afr. J. AIDS Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1080\/17441692.2019.1668452","article-title":"Characterising HIV\/AIDS knowledge and attitudes in the Middle East and North Africa: Systematic review and data synthesis","volume":"15","author":"Mumtaz","year":"2020","journal-title":"Glob. Public Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"S67","DOI":"10.1097\/01.aids.0000327438.13291.62","article-title":"Stigma in the HIV\/AIDS epidemic: A review of the literature and recommendations for the way forward","volume":"22","author":"Mahajan","year":"2008","journal-title":"Aids"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1093\/trstmh\/trac028","article-title":"Perceived stigma and healthcare services in healthcare settings among people living with HIV in Egypt: A qualitative study","volume":"116","author":"Elsharkawy","year":"2022","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Moussa, A.B., Delabre, R.M., Villes, V., Elkhammas, M., Bennani, A., Ouarsas, L., Filali, H., Alami, K., Karkouri, M., and Castro, D.R. (2021). Determinants and effects or consequences of internal HIV-related stigma among people living with HIV in Morocco. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-10204-1"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s12981-025-00834-5","article-title":"Stigma as a barrier to HIV care: A single center study in Egypt","volume":"23","author":"Magdy","year":"2026","journal-title":"AIDS Res. Ther."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Alia, S.M., Zoubeidi, T.L., and Ali, H.I. (2026). Nutrition-related knowledge, attitudes, practice, and mental health status of people living with HIV in Dubai, United Arab Emirates: A cross-sectional descriptive study. PLoS ONE, 21.","DOI":"10.1371\/journal.pone.0344288"},{"key":"ref_39","first-page":"90","article-title":"Prevalence and correlates of depressive symptoms among people living with HIV attending tertiary care hospitals in Oman","volume":"37","author":"Balkhair","year":"2020","journal-title":"Pan Afr. Med. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1093\/inthealth\/ihaf022","article-title":"Health-related quality of life of people living with HIV in Beni-Mellal City, Morocco","volume":"17","author":"Benaddi","year":"2025","journal-title":"Int. Health"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Madiba, S., Ralebona, E., and Lowane, M. (2021). Perceived Stigma as a Contextual Barrier to Early Uptake of HIV Testing, Treatment Initiation, and Disclosure; the Case of Patients Admitted with AIDS-Related Illness in a Rural Hospital in South Africa. Healthcare, 9.","DOI":"10.3390\/healthcare9080962"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1016\/j.ijid.2022.07.037","article-title":"Risk factors for late linkage to care and delayed antiretroviral therapy initiation among adults with HIV in sub-Saharan Africa: A systematic review and meta-analyses","volume":"122","author":"Fuge","year":"2022","journal-title":"Int. J. Infect. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"251","DOI":"10.26719\/2010.16.3.251","article-title":"HIV\/AIDS surveillance in Egypt: Current status and future challenges","volume":"16","author":"Boutros","year":"2010","journal-title":"East. Mediterr. Health J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e630","DOI":"10.1016\/S2352-3018(23)00223-0","article-title":"Has UNAIDS left the Middle East and north Africa behind?","volume":"10","author":"Rizk","year":"2023","journal-title":"Lancet HIV"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Giardina, F., Romero-Severson, E.O., Albert, J., Britton, T., and Leitner, T. (2017). Inference of Transmission Network Structure from HIV Phylogenetic Trees. PLoS Comput. Biol., 13.","DOI":"10.1371\/journal.pcbi.1005316"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1038\/s41467-019-09139-4","article-title":"Inferring HIV-1 transmission networks and sources of epidemic spread in Africa with deep-sequence phylogenetic analysis","volume":"10","author":"Ratmann","year":"2019","journal-title":"Nat. Commun."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1007\/s00038-013-0485-y","article-title":"HIV in the Middle East and North Africa: Priority, culture, and control","volume":"58","author":"Alkaiyat","year":"2013","journal-title":"Int. J. Public Health"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"477","DOI":"10.15171\/ijhpm.2016.149","article-title":"The Elephants in the Room: Sex, HIV, and LGBT Populations in MENA. Intersectionality in Lebanon Comment on \u201cImproving the Quality and Quantity of HIV Data in the Middle East and North Africa: Key Challenges and Ways Forward\u201d","volume":"6","author":"Kaplan","year":"2017","journal-title":"Int. J. Health Policy Manag."},{"key":"ref_49","unstructured":"Kelley, L.M., and Nicholas, E. (2005). Behind the Veil of a Public Health Crisis: HIV\/AIDS in the Muslim World, The National Bureau of Asian Research."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"103110","DOI":"10.1016\/j.jiph.2025.103110","article-title":"Consensus-based expert recommendations on the management of heavily treatment-experienced people living with HIV in the Middle East","volume":"19","author":"Omrani","year":"2026","journal-title":"J. Infect. Public Health"},{"key":"ref_51","unstructured":"Balkhy, H., and The WHO Regional Office for the Eastern Mediterranean (2026, May 07). Reimagining the HIV Response in the Eastern Mediterranean Region: Investment, Integration and Inclusion. Available online: https:\/\/www.emro.who.int\/media\/news\/opening-remarks-by-dr-hanan-balkhy-who-regional-director-at-the-aids-day-seminar-reimagining-the-hiv-response-in-the-eastern-mediterranean-region-investment-integration-and-inclusion.html."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1097\/QAD.0000000000000764","article-title":"Multiple co-circulating HIV-1 subtypes in the Middle East and North Africa","volume":"29","author":"Rolland","year":"2015","journal-title":"Aids"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1097\/01.aids.0000386729.56683.33","article-title":"Epidemiology of HIV infection in the Middle East and North Africa","volume":"24","author":"Hilmi","year":"2010","journal-title":"Aids"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1136\/sti.2010.043711","article-title":"HIV-1 molecular epidemiology evidence and transmission patterns in the Middle East and North Africa","volume":"87","author":"Mumtaz","year":"2011","journal-title":"Sex. Transm. Infect."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e00352","DOI":"10.1016\/j.heliyon.2017.e00352","article-title":"Genetic characterization of human immunodeficiency virus type 1 transmission in the Middle East and North Africa","volume":"3","author":"Sallam","year":"2017","journal-title":"Heliyon"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"65","DOI":"10.15171\/ijhpm.2016.112","article-title":"Improving the Quality and Quantity of HIV Data in the Middle East and North Africa: Key Challenges and Ways Forward","volume":"6","author":"Karamouzian","year":"2017","journal-title":"Int. J. Health Policy Manag."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"025370388","DOI":"10.36922\/EJMO025370388","article-title":"Viral suppression and immune recovery after antiretroviral therapy initiation in a Moroccan human immunodeficiency virus type 1-infected cohort: A retrospective analysis","volume":"10","author":"Ahmina","year":"2026","journal-title":"Eurasian J. Med. Oncol."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Ahmina, M., El Annaz, H., Lamrak, N., Reggad, A., Tagajdid, M.R., Abi, R., Elqatni, M., Laraqui, A., Elkochri, S., and Bouaiti, E. (2025). HIV-1 Subtype Diversity in Morocco: Signals of Change and Implications for National Surveillance. Infect. Dis. Rep., 17.","DOI":"10.3390\/idr17050128"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1089\/aid.2016.0164","article-title":"Genetic Diversity of HIV-1 in Tunisia","volume":"33","author":"Thomson","year":"2017","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1097\/QAD.0b013e32835cffd9","article-title":"Phylogenetic inferences on HIV-1 transmission: Implications for the design of prevention and treatment interventions","volume":"27","author":"Brenner","year":"2013","journal-title":"Aids"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1097\/QAD.0000000000001470","article-title":"Defining HIV-1 transmission clusters based on sequence data","volume":"31","author":"Hassan","year":"2017","journal-title":"Aids"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"13050","DOI":"10.1128\/JVI.00889-07","article-title":"Phylogenetic surveillance of viral genetic diversity and the evolving molecular epidemiology of human immunodeficiency virus type 1","volume":"81","author":"Gifford","year":"2007","journal-title":"J. Virol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1038\/nrg2583","article-title":"Evolutionary analysis of the dynamics of viral infectious disease","volume":"10","author":"Pybus","year":"2009","journal-title":"Nat. Rev. Genet."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1086\/651951","article-title":"Molecular epidemiology reveals long-term changes in HIV type 1 subtype B transmission in Switzerland","volume":"201","author":"Kouyos","year":"2010","journal-title":"J. Infect. Dis."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"10864","DOI":"10.1073\/pnas.93.20.10864","article-title":"Accurate reconstruction of a known HIV-1 transmission history by phylogenetic tree analysis","volume":"93","author":"Leitner","year":"1996","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1038\/s41564-018-0204-9","article-title":"Phylogenetic patterns recover known HIV epidemiological relationships and reveal common transmission of multiple variants","volume":"3","author":"Leitner","year":"2018","journal-title":"Nat. Microbiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/QAI.0000000000000271","article-title":"Phylogenetic studies of transmission dynamics in generalized HIV epidemics: An essential tool where the burden is greatest?","volume":"67","author":"Dennis","year":"2014","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s12985-025-02740-8","article-title":"Evaluating HIV drug resistance in the middle East and North Africa and its associated factors: A systematic review","volume":"22","author":"Khodadad","year":"2025","journal-title":"Virol. J."},{"key":"ref_69","first-page":"52","article-title":"HIV sequence databases","volume":"5","author":"Kuiken","year":"2003","journal-title":"AIDS Rev."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Athamneh, R.Y., Ar\u0131kan, A., Sayan, M., Mahafzah, A., and Sallam, M. (2021). Variable Proportions of Phylogenetic Clustering and Low Levels of Antiviral Drug Resistance among the Major HBV Sub-Genotypes in the Middle East and North Africa. Pathogens, 10.","DOI":"10.3390\/pathogens10101333"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1089\/aid.2012.0186","article-title":"Molecular epidemiology of HIV type 1 infection in Iran: Genomic evidence of CRF35_AD predominance and CRF01_AE infection among individuals associated with injection drug use","volume":"29","author":"Jahanbakhsh","year":"2013","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Eybpoosh, S., Bahrampour, A., Karamouzian, M., Azadmanesh, K., Jahanbakhsh, F., Mostafavi, E., Zolala, F., and Haghdoost, A.A. (2016). Spatio-Temporal History of HIV-1 CRF35_AD in Afghanistan and Iran. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0156499"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1159\/000484691","article-title":"CRF35-AD as the Main Circulating Genotype of Human Immunodeficiency Virus Type 1 Infection in Iran: A Phylogenetic and Demographic-Based Study","volume":"60","author":"Mozhgani","year":"2017","journal-title":"Intervirology"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1089\/aid.2009.0226","article-title":"Distinct circulating recombinant HIV-1 strains among injecting drug users and sex workers in Afghanistan","volume":"26","author":"Bose","year":"2010","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Rashid, A., Kang, L., Yi, F., Chu, Q., Shah, S.A., Mahmood, S.F., Getaneh, Y., Wei, M., Chang, S., and Abidi, S.H. (2024). Human Immunodeficiency Virus Type-1 Genetic Diversity and Drugs Resistance Mutations among People Living with HIV in Karachi, Pakistan. Viruses, 16.","DOI":"10.3390\/v16060962"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1111\/hiv.70109","article-title":"Molecular epidemiological analysis and investigation of antiretroviral drug resistance profile, including capsid inhibitors, among treatment-na\u00efve individuals with HIV-1 in T\u00fcrkiye","volume":"26","author":"Demir","year":"2025","journal-title":"HIV Med."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Wagner, T., Zuckerman, N.S., Halperin, T., Chemtob, D., Levy, I., Elbirt, D., Shachar, E., Olshtain-Pops, K., Elinav, H., and Chowers, M. (2021). Epidemiology and Transmitted HIV-1 Drug Resistance among Treatment-Na\u00efve Individuals in Israel, 2010\u20132018. Viruses, 14.","DOI":"10.3390\/v14010071"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2725","DOI":"10.1093\/molbev\/mst197","article-title":"MEGA6: Molecular Evolutionary Genetics Analysis version 6.0","volume":"30","author":"Tamura","year":"2013","journal-title":"Mol. Biol. Evol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1111\/j.1471-8286.2007.01821.x","article-title":"FaBox: An online toolbox for fasta sequences","volume":"7","author":"Villesen","year":"2007","journal-title":"Mol. Ecol. Notes"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1089\/aid.2006.22.367","article-title":"High diversity of HIV type 1 in Algeria","volume":"22","author":"Bouzeghoub","year":"2006","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1089\/aid.2008.0087","article-title":"First observation of HIV type 1 drug resistance mutations in Algeria","volume":"24","author":"Bouzeghoub","year":"2008","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1089\/aid.2015.0292","article-title":"Predominance of CRF06_cpx and Transmitted HIV Resistance in Algeria: Update 2013\u20132014","volume":"32","author":"Abdellaziz","year":"2016","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_83","first-page":"129","article-title":"Epidemiology and genetic characterization of HIV-1 isolates in the general population of Djibouti (Horn of Africa)","volume":"39","author":"Maslin","year":"2005","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1177\/135965350501000709","article-title":"Short communication. Antiretroviral drug resistance among drug-naive HIV-1-infected individuals in Djibouti (Horn of Africa)","volume":"10","author":"Maslin","year":"2005","journal-title":"Antivir. Ther."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1086\/315167","article-title":"Epidemic transmission of human immunodeficiency virus in renal dialysis centers in Egypt","volume":"181","author":"Gomatos","year":"2000","journal-title":"J. Infect. Dis."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"448","DOI":"10.2174\/1570162X19666210805091742","article-title":"Molecular Epidemiology of HIV-1 Virus in Egypt: A Major Change in the Circulating Subtypes","volume":"19","author":"Amer","year":"2021","journal-title":"Curr. HIV Res."},{"key":"ref_87","first-page":"318","article-title":"Human Immunodeficiency Virus Genotyping in Baghdad, Iraq","volume":"49","author":"Utba","year":"2022","journal-title":"Indian J. Ecol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1089\/aid.1996.12.641","article-title":"HIV type 1 subtypes B and C from new regions of India and Indian and Ethiopian expatriates in Kuwait","volume":"12","author":"Voevodin","year":"1996","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1002\/jmv.24212","article-title":"Phylogenetic analysis of HIV-1 subtypes and drug resistance profile among treatment-na\u00efve people in Kuwait","volume":"87","author":"Chehadeh","year":"2015","journal-title":"J. Med. Virol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1159\/000484692","article-title":"Resistance-Associated Mutations and Polymorphisms among Integrase Inhibitor-Na\u00efve HIV-1 Patients in Kuwait","volume":"60","author":"Chehadeh","year":"2017","journal-title":"Intervirology"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1159\/000488108","article-title":"Drug Resistance-Associated Mutations in Antiretroviral Treatment-Experienced Patients in Kuwait","volume":"27","author":"Chehadeh","year":"2018","journal-title":"Med. Princ. Pract."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"2040206620927908","DOI":"10.1177\/2040206620927908","article-title":"Virologic failure after 48 weeks of raltegravir-based regimen in low HIV-1 incidence setting","volume":"28","author":"Chehadeh","year":"2020","journal-title":"Antivir. Chem. Chemother."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"e0143221","DOI":"10.1128\/Spectrum.01432-21","article-title":"CODEHOP-Mediated PCR Improves HIV-1 Genotyping and Detection of Variants by MinION Sequencing","volume":"9","author":"Sarkhouh","year":"2021","journal-title":"Microbiol. Spectr."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"649","DOI":"10.3201\/eid0404.980418","article-title":"Introduction of HIV-2 and multiple HIV-1 subtypes to Lebanon","volume":"4","author":"Pieniazek","year":"1998","journal-title":"Emerg. Infect. Dis."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"2110","DOI":"10.1128\/JCM.39.6.2110-2114.2001","article-title":"Development of an env gp41-based heteroduplex mobility assay for rapid human immunodeficiency virus type 1 subtyping","volume":"39","author":"Agwale","year":"2001","journal-title":"J. Clin. Microbiol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1097\/00002030-200402200-00016","article-title":"HIV-2 protease sequences of subtypes A and B harbor multiple mutations associated with protease inhibitor resistance in HIV-1","volume":"18","author":"Pieniazek","year":"2004","journal-title":"Aids"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1086\/322036","article-title":"Nosocomial outbreak of multiple bloodborne viral infections","volume":"184","author":"Yerly","year":"2001","journal-title":"J. Infect. Dis."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1089\/088922202760072366","article-title":"Monophyletic HIV type 1 CRF02-AG in a nosocomial outbreak in Benghazi, Libya","volume":"18","author":"Cappiello","year":"2002","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1002\/jmv.23860","article-title":"Drug resistance mutations and genetic diversity in adults treated for HIV type 1 infection in Mauritania","volume":"86","author":"Lo","year":"2014","journal-title":"J. Med. Virol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1089\/aid.2010.0284","article-title":"Presence of drug resistance mutations among drug-naive patients in Morocco","volume":"27","author":"Annaz","year":"2011","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1089\/aid.2011.0278","article-title":"Drug resistance mutations in HIV type 1 isolates from patients failing antiretroviral therapy in Morocco","volume":"28","author":"Tagajdid","year":"2012","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1089\/aid.2011.0225","article-title":"Characterization of protease resistance-associated mutations in HIV type 1 drug-naive patients following the increasing prevalence of the CRF02_AG strain in Morocco","volume":"28","author":"Miri","year":"2012","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/1742-6405-9-5","article-title":"HIV-1 Subtype distribution in morocco based on national sentinel surveillance data 2004\u20132005","volume":"9","author":"Akrim","year":"2012","journal-title":"AIDS Res. Ther."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Alaoui, N., El Alaoui, M.A., Touil, N., El Annaz, H., Melloul, M., Tagajdid, R., Hjira, N., Boui, M., El Fahime, E.M., and Mrani, S. (2018). Prevalence of resistance to integrase strand-transfer inhibitors (INSTIs) among untreated HIV-1 infected patients in Morocco. BMC Res. Notes, 11.","DOI":"10.1186\/s13104-018-3492-5"},{"key":"ref_105","unstructured":"Al Kindi, H.S., Al Amri, A.S., Pradeesh, J., Al Shukri, I., and Pulikkathodi, F.S. (2026, May 03). Direct Submission from Oman, Available online: https:\/\/www.ncbi.nlm.nih.gov\/nucleotide\/PX777636."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1089\/aid.2007.0185","article-title":"Identification and characterization of HIV type 1 subtypes present in the Kingdom of Saudi Arabia: High level of genetic diversity found","volume":"23","author":"Badreddine","year":"2007","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1089\/aid.2008.0101","article-title":"Identification of new CRF43_02G and CRF25_cpx in Saudi Arabia based on full genome sequence analysis of six HIV type 1 isolates","volume":"24","author":"Yamaguchi","year":"2008","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"e23274","DOI":"10.1097\/MD.0000000000023274","article-title":"Genotyping and antiretroviral drug resistance of human immunodeficiency Virus-1 in Jazan, Saudi Arabia","volume":"99","author":"Zaki","year":"2020","journal-title":"Medicine"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1128\/jvi.69.1.263-271.1995","article-title":"Genetic diversity of the envelope glycoprotein from human immunodeficiency virus type 1 isolates of African origin","volume":"69","author":"Louwagie","year":"1995","journal-title":"J. Virol."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1089\/088922202320567923","article-title":"HIV type 1 strains from East and West Africa are intermixed in Sudan","volume":"18","author":"Hierholzer","year":"2002","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1089\/aid.2019.0133","article-title":"Characterization of HIV-1 Subtypes Among South Sudanese Patients","volume":"35","author":"Farcomeni","year":"2019","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"3320","DOI":"10.1002\/jmv.27713","article-title":"Analysis of HIV-1 integrase genotypes and polymorphisms among integrase inhibitors-based antiretroviral treatment na\u00efve patients in South Sudan","volume":"94","author":"Giovanetti","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1097\/00042560-200109010-00014","article-title":"First molecular characterization of HIV-1 Tunisian strains","volume":"28","author":"Pasquier","year":"2001","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1089\/aid.2005.21.644","article-title":"HIV type 1 strains common in Europe, Africa, and Asia cocirculate in Yemen","volume":"21","author":"Saad","year":"2005","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1038\/313277a0","article-title":"Complete nucleotide sequence of the AIDS virus, HTLV-III","volume":"313","author":"Ratner","year":"1985","journal-title":"Nature"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"e0174923","DOI":"10.1128\/mbio.01749-23","article-title":"HIV-1 Gag, Pol, and Env diversified with limited adaptation since the 1980s","volume":"15","author":"Lewitus","year":"2024","journal-title":"mBio"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1097\/00002030-200403260-00002","article-title":"HIV-1 pol gene variation is sufficient for reconstruction of transmissions in the era of antiretroviral therapy","volume":"18","author":"Clewley","year":"2004","journal-title":"Aids"},{"key":"ref_118","doi-asserted-by":"crossref","unstructured":"Thompson, J.D., Gibson, T.J., and Higgins, D.G. (2003). Multiple sequence alignment using ClustalW and ClustalX. Curr. Protoc. Bioinform., 2.3.1\u20132.3.22.","DOI":"10.1002\/0471250953.bi0203s00"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1093\/molbev\/mst012","article-title":"Building phylogenetic trees from molecular data with MEGA","volume":"30","author":"Hall","year":"2013","journal-title":"Mol. Biol. Evol."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S0076-6879(96)66024-8","article-title":"Using CLUSTAL for multiple sequence alignments","volume":"266","author":"Higgins","year":"1996","journal-title":"Methods Enzymol."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"4673","DOI":"10.1093\/nar\/22.22.4673","article-title":"CLUSTAL W: Improving the sensitivity of progressive multiple sequence alignment through sequence weighting, position-specific gap penalties and weight matrix choice","volume":"22","author":"Thompson","year":"1994","journal-title":"Nucleic Acids Res."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"3896","DOI":"10.1128\/JCM.00515-08","article-title":"Reliability of rapid subtyping tools compared to that of phylogenetic analysis for characterization of human immunodeficiency virus type 1 non-B subtypes and recombinant forms","volume":"46","author":"Soriano","year":"2008","journal-title":"J. Clin. Microbiol."},{"key":"ref_123","doi-asserted-by":"crossref","unstructured":"Smoquina, F., Berno, G., Forbici, F., Sberna, G., Rozera, G., Abbate, I., Lazzari, E., Amendola, A., Mazzotta, V., and Gagliardini, R. (2025). Improved HIV-1 Subtyping Accuracy Using near Full-Length Sequencing: A Comparison of Common Tools. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms262311666"},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1093\/sysbio\/syq010","article-title":"New algorithms and methods to estimate maximum-likelihood phylogenies: Assessing the performance of PhyML 3.0","volume":"59","author":"Guindon","year":"2010","journal-title":"Syst. Biol."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1080\/10635150390235520","article-title":"A simple, fast, and accurate algorithm to estimate large phylogenies by maximum likelihood","volume":"52","author":"Guindon","year":"2003","journal-title":"Syst. Biol."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1093\/sysbio\/syr041","article-title":"Survey of branch support methods demonstrates accuracy, power, and robustness of fast likelihood-based approximation schemes","volume":"60","author":"Anisimova","year":"2011","journal-title":"Syst. Biol."},{"key":"ref_127","unstructured":"Rambaut, A., and Drummond, A.J. (2026, May 04). Molecular Evolution, Phylogenetics and Epidemiology: FigTree v.1.4.4. Available online: https:\/\/tree.bio.ed.ac.uk\/software\/figtree\/."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1093\/bioinformatics\/btg412","article-title":"APE: Analyses of Phylogenetics and Evolution in R language","volume":"20","author":"Paradis","year":"2004","journal-title":"Bioinformatics"},{"key":"ref_129","doi-asserted-by":"crossref","unstructured":"Abidi, S.H., Nduva, G.M., Siddiqui, D., Rafaqat, W., Mahmood, S.F., Siddiqui, A.R., Nathwani, A.A., Hotwani, A., Shah, S.A., and Memon, S. (2021). Phylogenetic and Drug-Resistance Analysis of HIV-1 Sequences From an Extensive Paediatric HIV-1 Outbreak in Larkana, Pakistan. Front. Microbiol., 12.","DOI":"10.3389\/fmicb.2021.658186"},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"vew010","DOI":"10.1093\/ve\/vew010","article-title":"HIV-1 transmission between MSM and heterosexuals, and increasing proportions of circulating recombinant forms in the Nordic Countries","volume":"2","author":"Mild","year":"2016","journal-title":"Virus Evol."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1093\/bioinformatics\/btp134","article-title":"The calibrated population resistance tool: Standardized genotypic estimation of transmitted HIV-1 drug resistance","volume":"25","author":"Gifford","year":"2009","journal-title":"Bioinformatics"},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1086\/503914","article-title":"Web resources for HIV type 1 genotypic-resistance test interpretation","volume":"42","author":"Liu","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"e25611","DOI":"10.1002\/jia2.25611","article-title":"HIV-1 transmitted drug resistance surveillance: Shifting trends in study design and prevalence estimates","volume":"23","author":"Rhee","year":"2020","journal-title":"J. Int. AIDS Soc."},{"key":"ref_134","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_135","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1186\/s12985-025-02916-2","article-title":"What leads to treatment failure among people living with HIV: First systematic review from the middle east and North Africa","volume":"22","author":"Safari","year":"2025","journal-title":"Virol. J."},{"key":"ref_136","first-page":"1","article-title":"HIV-1 genotyping and drug resistance mutations in Morocco (2009\u20132024): A systematic review addressing critical gaps in molecular surveillance","volume":"28","author":"Ahmina","year":"2025","journal-title":"AIDS Rev."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"134","DOI":"10.5501\/wjv.v4.i2.134","article-title":"Early initiation of antiretroviral treatment: Challenges in the Middle East and North Africa","volume":"4","author":"Sardashti","year":"2015","journal-title":"World J. Virol."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"58","DOI":"10.5334\/aogh.4491","article-title":"Predictors of Adherence to Antiretroviral Therapy among People Living with HIV in Northern Egypt","volume":"90","author":"Magdy","year":"2024","journal-title":"Ann. Glob. Health"},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"490","DOI":"10.5001\/omj.2019.91","article-title":"HIV Drug Resistance among Patients Failing Therapy at a Tertiary Center in Oman: A Case Record Review","volume":"34","author":"Elgalib","year":"2019","journal-title":"Oman Med. J."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"100912","DOI":"10.1016\/S2666-5247(24)00151-4","article-title":"Global and regional genetic diversity of HIV-1 in 2010\u201321: Systematic review and analysis of prevalence","volume":"5","author":"Nair","year":"2024","journal-title":"Lancet Microbe"},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"69","DOI":"10.5501\/wjv.v10.i2.69","article-title":"Epidemiological characterization and geographic distribution of human immunodeficiency virus\/acquired immunodeficiency syndrome infection in North African countries","volume":"10","author":"Daw","year":"2021","journal-title":"World J. Virol."},{"key":"ref_142","first-page":"109","article-title":"Impact of immigration on HIV-1 molecular epidemiology in West Africa, Maghreb and Southern Europe","volume":"16","author":"Miri","year":"2014","journal-title":"AIDS Rev."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1093\/eurpub\/cku109","article-title":"Infectious diseases in North Africa and North African immigrants to Europe","volume":"24","author":"Khyatti","year":"2014","journal-title":"Eur. J. Public Health"},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1089\/aid.2018.0292","article-title":"HIV Infection in North African Patients","volume":"35","author":"Parisey","year":"2019","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"819","DOI":"10.26719\/2002.8.6.819","article-title":"Some characteristics of the HIV epidemic in Morocco","volume":"8","author":"Elharti","year":"2002","journal-title":"East. Mediterr. Health J."},{"key":"ref_146","doi-asserted-by":"crossref","unstructured":"Daw, M.A., El-Bouzedi, A., Ahmed, M.O., and Dau, A.A. (2017). In association with the Libyan Study Group of Hepatitis; HIV. Molecular and epidemiological characterization of HIV-1 subtypes among Libyan patients. BMC Res. Notes, 10.","DOI":"10.1186\/s13104-017-2491-2"},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.meegid.2016.05.017","article-title":"Phylodynamics of the major HIV-1 CRF02_AG African lineages and its global dissemination","volume":"46","author":"Mir","year":"2016","journal-title":"Infect. Genet. Evol."},{"key":"ref_148","doi-asserted-by":"crossref","unstructured":"Giovanetti, M., Ciccozzi, M., Parolin, C., and Borsetti, A. (2020). Molecular Epidemiology of HIV-1 in African Countries: A Comprehensive Overview. Pathogens, 9.","DOI":"10.3390\/pathogens9121072"},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s40878-024-00390-3","article-title":"Labor migration, remittances, and the economy in the Gulf Cooperation Council region","volume":"12","author":"Wagle","year":"2024","journal-title":"Comp. Migr. Stud."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1016\/j.jiph.2023.06.012","article-title":"Human immunodeficiency virus in Saudi Arabia: Current and future challenges","volume":"16","author":"Dirar","year":"2023","journal-title":"J. Infect. Public Health"},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1099\/jmm.0.001186","article-title":"HIV serology false positivity among expatriates from Africa: A screening dilemma","volume":"69","year":"2020","journal-title":"J. Med. Microbiol."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"107079","DOI":"10.1016\/j.ijid.2024.107079","article-title":"Clinical, molecular, and drug resistance epidemiology of HIV in Jordan, 2019\u20132021: A national study","volume":"145","author":"Bakri","year":"2024","journal-title":"Int. J. Infect. Dis."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"33971","DOI":"10.1038\/srep33971","article-title":"Multiple introductions and onward transmission of non-pandemic HIV-1 subtype B strains in North America and Europe","volume":"6","author":"Cabello","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"2479","DOI":"10.1097\/QAD.0b013e328330cc08","article-title":"HIV-1 subtypes and differences in heterosexual HIV transmission among HIV-discordant couples in Rakai, Uganda","volume":"23","author":"Kiwanuka","year":"2009","journal-title":"Aids"},{"key":"ref_155","first-page":"vex029","article-title":"The substitution rate of HIV-1 subtypes: A genomic approach","volume":"3","year":"2017","journal-title":"Virus Evol."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"vex013","DOI":"10.1093\/ve\/vex013","article-title":"Rising prevalence of non-B HIV-1 subtypes in North Carolina and evidence for local onward transmission","volume":"3","author":"Dennis","year":"2017","journal-title":"Virus Evol."},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1093\/infdis\/jiv758","article-title":"Transmission of Non-B HIV Subtypes in the United Kingdom Is Increasingly Driven by Large Non-Heterosexual Transmission Clusters","volume":"213","author":"Lycett","year":"2016","journal-title":"J. Infect. Dis."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/s12939-025-02461-y","article-title":"HIV\/AIDS among migrants in Morocco: A cross-sectional biobehavioral study","volume":"24","author":"Yacoubi","year":"2025","journal-title":"Int. J. Equity Health"},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"110558","DOI":"10.1016\/j.virol.2025.110558","article-title":"Threshold sensitivity analysis for HIV-1 transmission cluster detection using different genomic regions and subtypes","volume":"608","author":"Obeng","year":"2025","journal-title":"Virology"},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1089\/aid.2018.0181","article-title":"Estimating Effects of HIV Sequencing Data Completeness on Transmission Network Patterns and Detection of Growing HIV Transmission Clusters","volume":"35","author":"Dasgupta","year":"2019","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"222","DOI":"10.2991\/jegh.k.191208.001","article-title":"The Epidemiology of HIV in Oman, 1984\u20132018: A Nationwide Study from the Middle East","volume":"10","author":"Elgalib","year":"2020","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1089\/aid.2004.20.1166","article-title":"Human immunodeficiency virus type 1 infection in Oman: Antiretroviral therapy and frequencies of drug resistance mutations","volume":"20","author":"Scrimgeour","year":"2004","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_163","doi-asserted-by":"crossref","unstructured":"Sannathimmappa, M.B., Al-Maqbali, S., Divecha, C., Hawal, M., Aravindakshan, R., Al-Hosni, K., Al-Risi, E.S., and Nambiar, V. (2026). Unveiling the HIV Landscape in Oman: A Retrospective Study of Prevalence, Risk Factors, Treatment Efficacy and Clinical Outcomes. Sci, 8.","DOI":"10.3390\/sci8010016"},{"key":"ref_164","doi-asserted-by":"crossref","unstructured":"Elgalib, A., Shah, S., Al-Wahaibi, A., Al-Habsi, Z., Al-Fouri, M., Lau, R., Al-Kindi, H., Al-Rawahi, B., and Al-Abri, S. (2021). Disparities between HIV patient subgroups in Oman: An analysis of the 2019 cascade of care. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0254474"},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"iii49","DOI":"10.1136\/sextrans-2012-050844","article-title":"The distribution of new HIV infections by mode of exposure in Morocco","volume":"89","author":"Mumtaz","year":"2013","journal-title":"Sex. Transm. Infect."},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1177\/0956462413477971","article-title":"The epidemiology of HIV infection in Morocco: Systematic review and data synthesis","volume":"24","author":"Kouyoumjian","year":"2013","journal-title":"Int. J. STD AIDS"},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.ijid.2017.12.013","article-title":"Mapping of new HIV infections in Morocco and impact of select interventions","volume":"68","author":"Kouyoumjian","year":"2018","journal-title":"Int. J. Infect. Dis."},{"key":"ref_168","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.antiviral.2009.10.003","article-title":"Fifteen years of HIV Protease Inhibitors: Raising the barrier to resistance","volume":"85","author":"Wensing","year":"2010","journal-title":"Antivir. Res."},{"key":"ref_169","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.antiviral.2007.06.010","article-title":"Protease inhibitor resistance in HIV-infected patients: Molecular and clinical perspectives","volume":"76","author":"Wainberg","year":"2007","journal-title":"Antivir. Res."},{"key":"ref_170","doi-asserted-by":"crossref","first-page":"109","DOI":"10.4314\/ahs.v23i2.12","article-title":"Biological parameters determining the effectiveness of monitoring of HIV\/AIDS infected patients in Morocco","volume":"23","author":"Echchakery","year":"2023","journal-title":"Afr. Health Sci."},{"key":"ref_171","doi-asserted-by":"crossref","unstructured":"Zhang, H., Wu, P., and Ye, W. (2026). HIV-1 drug resistance and associated risk factors in patients with antiretroviral therapy failure in Chongqing, China, 2019\u20132023. PLoS ONE, 21.","DOI":"10.1371\/journal.pone.0342301"},{"key":"ref_172","doi-asserted-by":"crossref","unstructured":"Kayinda, F., Awor, P., Mahaba, T., Muganzi, A.M., Kigozi, J., Olwedo, P.O., Nasuuna, E.M., Mutumba, R., and Wanyenze, R. (2025). Prevalence of HIV drug resistance, its correlates and common mutations among people living with HIV failing on ART in northern Uganda: A cross-sectional study. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0320623"},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/S1473-3099(17)30702-8","article-title":"HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: A systematic review and meta-regression analysis","volume":"18","author":"Gupta","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_174","doi-asserted-by":"crossref","first-page":"2475","DOI":"10.1128\/AAC.44.9.2475-2484.2000","article-title":"Human immunodeficiency virus type 1 mutations selected in patients failing efavirenz combination therapy","volume":"44","author":"Bacheler","year":"2000","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"9132","DOI":"10.4076\/1752-1947-3-9132","article-title":"Rapid and persistent selection of the K103N mutation as a majority quasispecies in a HIV1-patient exposed to efavirenz for three weeks: A case report and review of the literature","volume":"3","author":"Polilli","year":"2009","journal-title":"J. Med. Case Rep."},{"key":"ref_176","doi-asserted-by":"crossref","unstructured":"Reddy, N., Papathanasopoulos, M., Steegen, K., and Basson, A.E. (2024). K103N, V106M and Y188L Significantly Reduce HIV-1 Subtype C Phenotypic Susceptibility to Doravirine. Viruses, 16.","DOI":"10.20944\/preprints202408.2163.v1"},{"key":"ref_177","unstructured":"Saxena, S.K. (2025). The Evolution of HIV-1 Drug Resistance and Genetic Variability under HAART Pressure. Viral Infectious Diseases Annual Volume 2025, IntechOpen."},{"key":"ref_178","doi-asserted-by":"crossref","first-page":"3478","DOI":"10.1128\/AAC.47.11.3478-3484.2003","article-title":"Tenofovir resistance and resensitization","volume":"47","author":"Wolf","year":"2003","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_179","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.antiviral.2009.10.018","article-title":"The evolution of HIV treatment guidelines: Current state-of-the-art of ART","volume":"85","author":"Zolopa","year":"2010","journal-title":"Antivir. Res."},{"key":"ref_180","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.antiviral.2013.12.007","article-title":"Evolution of HIV treatment guidelines in high- and low-income countries: Converging recommendations","volume":"103","author":"Richardson","year":"2014","journal-title":"Antivir. Res."},{"key":"ref_181","doi-asserted-by":"crossref","unstructured":"Apetroaei, M.M., Velescu, B., Nedea, M.I.I., Dinu-P\u00eervu, C.E., Dr\u0103g\u0103nescu, D., F\u00e2c\u0103, A.I., Udeanu, D.I., and Arsene, A.L. (2024). The Phenomenon of Antiretroviral Drug Resistance in the Context of Human Immunodeficiency Virus Treatment: Dynamic and Ever Evolving Subject Matter. Biomedicines, 12.","DOI":"10.3390\/biomedicines12040915"},{"key":"ref_182","doi-asserted-by":"crossref","first-page":"ofaf446","DOI":"10.1093\/ofid\/ofaf446","article-title":"HIV-1 Drug Resistance Trends in the Era of Modern Antiretrovirals: 2018\u20132024","volume":"12","author":"Kagan","year":"2025","journal-title":"Open Forum Infect. Dis."},{"key":"ref_183","first-page":"559","article-title":"2022 update of the drug resistance mutations in HIV-1","volume":"30","author":"Wensing","year":"2022","journal-title":"Top. Antivir. Med."},{"key":"ref_184","first-page":"457","article-title":"2025 update of the drug resistance mutations in HIV-1","volume":"33","author":"Wensing","year":"2025","journal-title":"Top. Antivir. Med."},{"key":"ref_185","first-page":"67","article-title":"HIV-1 drug resistance mutations: An updated framework for the second decade of HAART","volume":"10","author":"Shafer","year":"2008","journal-title":"AIDS Rev."},{"key":"ref_186","doi-asserted-by":"crossref","unstructured":"Johnson, M.M., Jones, C.E., and Clark, D.N. (2022). The Effect of Treatment-Associated Mutations on HIV Replication and Transmission Cycles. Viruses, 15.","DOI":"10.3390\/v15010107"},{"key":"ref_187","doi-asserted-by":"crossref","first-page":"vex008","DOI":"10.1093\/ve\/vex008","article-title":"Transmission fitness of drug-resistant HIV revealed in a surveillance system transmission network","volume":"3","author":"Wertheim","year":"2017","journal-title":"Virus Evol."},{"key":"ref_188","doi-asserted-by":"crossref","first-page":"194","DOI":"10.35772\/ghm.2023.01013","article-title":"Four decades of continuing innovations in the development of antiretroviral therapy for HIV\/AIDS: Progress to date and future challenges","volume":"5","author":"Ghosh","year":"2023","journal-title":"Glob. Health Med."},{"key":"ref_189","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1016\/j.coviro.2012.08.006","article-title":"Are subtype differences important in HIV drug resistance?","volume":"2","author":"Lessells","year":"2012","journal-title":"Curr. Opin. Virol."},{"key":"ref_190","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.meegid.2016.06.047","article-title":"Differences among HIV-1 subtypes in drug resistance against integrase inhibitors","volume":"46","author":"Han","year":"2016","journal-title":"Infect. Genet. Evol."},{"key":"ref_191","doi-asserted-by":"crossref","first-page":"35936","DOI":"10.1038\/s41598-025-04144-8","article-title":"In vitro comparison of the susceptibilities of the same drug resistance mutations to reverse-transcriptase inhibitors of subtype B and CRF01_AE HIV-1 strains","volume":"15","author":"Li","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_192","doi-asserted-by":"crossref","first-page":"e506","DOI":"10.1016\/S2352-3018(22)00093-5","article-title":"Status of the HIV epidemic in key populations in the Middle East and north Africa: Knowns and unknowns","volume":"9","author":"Mumtaz","year":"2022","journal-title":"Lancet HIV"},{"key":"ref_193","doi-asserted-by":"crossref","unstructured":"Frescura, L., Godfrey-Faussett, P., Feizzadeh, A.A., El-Sadr, W., Syarif, O., and Ghys, P.D. (2022). Achieving the 95 95 95 targets for all: A pathway to ending AIDS. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0272405"},{"key":"ref_194","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s44197-023-00097-1","article-title":"Progress of the Gulf Cooperation Council (GCC) Countries Towards Achieving the 95-95-95 UNAIDS Targets: A Review","volume":"13","author":"Awaidy","year":"2023","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref_195","doi-asserted-by":"crossref","unstructured":"Ghazy, R.M., Al Awaidy, S., and Taha, S.H.N. (2023). Trends of HIV indicators in Egypt from 1990 to 2021: Time-series analysis and forecast toward UNAIDS 90\u201390\u201390 targets. BMC Public Health, 23.","DOI":"10.1186\/s12889-023-15490-5"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/8\/897\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T13:14:30Z","timestamp":1786713270000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/8\/897"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":195,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["v18080897"],"URL":"https:\/\/doi.org\/10.3390\/v18080897","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,14]]}}}