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Proc Natl Acad Sci U S A. 2018 Jan 30;115(5):1051-1056. doi: 10.1073/pnas.1701447115. Epub 2018 Jan 16.

Molecular epidemiology reveals the role of war in the spread of HIV in Ukraine.

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Department of Zoology, University of Oxford, OX2 6GG, Oxford, United Kingdom;
L. V. Gromashevskij Institute of Epidemiology and Infectious Diseases, National Academy of Sciences of Ukraine, Kyiv 03680, Ukraine.
Institute for Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY 10010.
Alliance for Public Health, Kyiv 03680, Ukraine.
Department of Zoology, University of Oxford, OX2 6GG, Oxford, United Kingdom.
Virus Reference Department, National Infection Services, Public Health England, NW9 5HT, London, United Kingdom.
Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens 115 27, Greece.


Ukraine has one of the largest HIV epidemics in Europe, historically driven by people who inject drugs (PWID). The epidemic showed signs of stabilization in 2012, but the recent war in eastern Ukraine may be reigniting virus spread. We investigated the movement of HIV-infected people within Ukraine before and during the conflict. We analyzed HIV-1 subtype-A pol nucleotide sequences sampled during 2012-2015 from 427 patients of 24 regional AIDS centers and used phylogeographic analysis to reconstruct virus movement among different locations in Ukraine. We then tested for correlations between reported PWID behaviors and reconstructed patterns of virus spread. Our analyses suggest that Donetsk and Lugansk, two cities not controlled by the Ukrainian government in eastern Ukraine, were significant exporters of the virus to the rest of the country. Additional analyses showed that viral dissemination within the country changed after 2013. Spearman correlation analysis showed that incoming virus flow was correlated with the number of HIV-infected internally displaced people. Additionally, there was a correlation between more intensive virus movement and locations with a higher proportion of PWID practicing risky sexual behaviors. Our findings suggest that effective prevention responses should involve internally displaced people and people who frequently travel to war-affected regions. Scale-up of harm reduction services for PWID will be an important factor in preventing new local HIV outbreaks in Ukraine.


HIV; Ukraine; people who inject drugs; phylogeography; war

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