Mobile Lab Tracks HIV Spread in War-Torn Ukraine, Uncovers Drug-Resistant Strain

Ukraine - Ekhbary News Agency

Mobile Lab Tracks HIV Spread in War-Torn Ukraine, Uncovers Drug-Resistant Strain

In the midst of the ongoing conflict in Ukraine, a mobile laboratory has emerged as a crucial tool in monitoring the spread and evolution of HIV across the war-ravaged country. This innovative approach has yielded a significant early success: the discovery of a new, drug-resistant strain of HIV, raising fresh concerns for public health in a region already under immense strain.

The invasion of Ukraine has severely disrupted healthcare services, creating conditions conducive to the unchecked spread of diseases like HIV. Gauging the precise rate of contagion has been a formidable challenge. However, by equipping a van with portable research gear, virologist Ganna (Anna) Kovalenko and her team from the University of California, Irvine, are probing the hidden threat posed by HIV in this war-torn nation.

HIV has been present in Ukraine since the 1990s, primarily transmitted through intravenous drug use and sexual activity. The Russian annexation of Crimea in 2014 and the full-scale invasion beginning in 2022 have drastically exacerbated the situation. Access to essential testing, treatment, and preventative measures, such as needle exchange programs, has been severely curtailed, creating a more favorable environment for the virus to spread and potentially mutate.

Even where testing facilities remain operational, clinicians often do not routinely perform viral genome sequencing to identify concerning mutations, including those conferring drug resistance. This limitation stems largely from the fact that sequencing technology is typically housed in stationary laboratories, which are often situated far from areas where the virus may be actively spreading or where populations are most vulnerable.

This is precisely the gap that the ARTIC network aims to fill. This initiative focuses on deploying sequencing tools to remote or inaccessible locations, a strategy successfully employed during the 2014 Ebola outbreaks in West Africa. Inspired by this success, Dr. Kovalenko, a participant in the ARTIC network, questioned whether portable sequencing tools could be effectively applied to other emergency scenarios, such as mapping HIV transmission dynamics within Ukraine.

Driven by this inquiry, she and her colleagues embarked on a project to create a "lab on wheels." In August 2024, during a test run, Kovalenko and her team drove their mobile laboratory to Lviv, a city in western Ukraine serving as a relatively safe hub for internally displaced persons fleeing the front lines. "We worked during the daytime. Most missile attacks happened at night," she recounted. Over three days spent in the van, Kovalenko engaged with numerous local healthcare workers who shared their profound frustrations with the ongoing conflict. They described harrowing situations where missile attacks occurred during daylight hours while they were providing care, forcing immediate evacuations and leaving behind critical equipment.

Historically, HIV surveillance relied heavily on stationary clinics. For instance, Dr. Casper Rokx, an HIV specialist at Erasmus MC in Rotterdam, Netherlands, established stationary clinics in Lviv to provide HIV care between 2023 and 2025. However, he acknowledged the limitations: "We didn’t reach the hard-to-reach populations, at least not as effectively as we wanted that to be." He contrasted this with the mobility of their new approach, stating, "vans can just drive to where people are."

During their initial field test, Kovalenko's team collected blood samples from 20 individuals living with HIV. Initially, Dr. Kovalenko anticipated finding little of note with such a small sample size, primarily aiming to demonstrate the feasibility of the mobile lab concept. To their surprise, the researchers identified an HIV strain that had emerged among displaced individuals in Lviv following the escalation of the war. The team reported their findings in the journal AIDS.

"It gives us direct evidence that war and displacement change how HIV spreads," Dr. Kovalenko stated. By comparing the genetic makeup of this newly identified strain with HIV genomes sequenced in 2020, and considering the virus's mutation rate, the researchers estimate that this distinct variant emerged after Russia's expanded invasion in 2022.

Furthermore, the team detected a mutation within a viral gene that confers resistance to a backup antiretroviral medication. This discovery serves as a significant warning. Dr. Rokx emphasized the potential implications, noting that further sequencing of HIV from displaced populations could reveal other resistance mutations affecting first-line drugs. "That’s not as hypothetical as we first thought it would be," he commented, adding that drug resistance to primary HIV treatments is an escalating global concern, citing South Africa as an example.

Looking ahead, Dr. Kovalenko plans to explore broader applications for their mobile laboratory. She highlighted the critical issue of antimicrobial resistance, particularly on the front lines where soldiers frequently sustain infected wounds. Sequencing bacterial genomes could guide clinicians in selecting the most effective antibiotics. Both Kovalenko and Rokx also pointed to tuberculosis as a growing health burden in Ukraine, noting that the bacteria responsible for TB often exhibit multi-drug resistance.

While the war has inadvertently created a "smokescreen" allowing HIV to spread and mutate, this mobile laboratory offers a promising means for researchers to cut through the obscurity. "I think what they nicely did was bring deep sequencing and advanced laboratory technique to a population in need," remarked Dr. Rokx, underscoring the project's value in delivering cutting-edge science to vulnerable communities.

Ekhbary News Agency