# HIV-1 Genetic Diversity and Transmitted Drug Resistance Mutations in ART-Naïve Individuals in South Korea from 2021 to 2024

## TL;DR

This study examines HIV-1 genetic diversity and drug resistance mutations in South Korea from 2021 to 2024 to guide better treatment strategies.

## Contribution

The study provides updated insights into HIV-1 subtype distribution and transmitted drug resistance in South Korea, highlighting changing trends and regional differences.

## Key findings

- Subtype B was most prevalent at 50.7%, but its proportion decreased annually.
- TDR across antiretroviral drug classes was approximately 3.5% in South Korea.
- Non-nucleoside reverse transcriptase inhibitors showed the highest drug resistance.

## Abstract

In this study, we investigated the proportion of transmitted drug resistance (TDR) mutations and human immunodeficiency virus (HIV)-1 subtypes among 487 antiretroviral therapy (ART)-naïve individuals in South Korea from 2021 to 2024 to inform more effective treatment strategies. Consistent with previous reports, subtype B was most prevalent among HIV-1 subtypes at 50.7%; however, its proportion decreased annually (p = 0.047). Various subtypes of circulating recombinant forms (CRFs) were analyzed in this study, resulting in high genetic diversity. The subtype distributions of Korean and non-Korean patients differed, with subtype B (53.7%) and CRF01_AE (34.4%) being dominant in the former and latter, respectively. TDR across antiretroviral drug classes was approximately 3.5% in South Korea. Non-nucleoside reverse transcriptase inhibitors elicited the greatest drug resistance, which increased from 2021 to 2023, with a slight decrease in 2024. The integrase strand transfer inhibitor drugs, elvitegravir and raltegravir, most frequently exhibited high resistance scores. We provide a comprehensive overview of the HIV-1 genetic distribution and TDR patterns in South Korea from 2021 to 2024. Within the broader context of HIV-1 epidemiology in Asia and the Pacific, the findings contribute to a comprehensive understanding of the global distribution of HIV-1 resistance and genotypes, enabling the development of effective interventions.