Mobile Lab Tracks HIV Evolution in Ukraine, Reveals Drug Resistance

The ongoing conflict in Ukraine is not only a humanitarian crisis but also a catalyst for the accelerated evolution of HIV, potentially leading to drug-resistant strains. A team led by virologist Ganna Kovalenko is responding with an innovative approach: a mobile laboratory housed within a van, bringing genomic sequencing directly to the frontlines of the public health challenge. This initiative offers a crucial window into how war and displacement impact viral transmission and treatment.

HIV has been present in Ukraine since the 1990s, primarily spread through intravenous drug use, though sexual transmission also contributes. The Russian invasion, beginning in 2014 and escalating significantly in 2022, has severely hampered access to essential HIV prevention and treatment services, including testing, antiretroviral therapy, and needle exchange programs. This disruption creates a fertile ground for the virus to evolve.

A Van-Based Solution to a Complex Problem

Traditionally, HIV genome sequencing – a vital tool for tracking viral mutations and identifying drug resistance – is confined to stationary laboratories, often located far from areas most affected by the conflict. Recognizing this limitation, Kovalenko, a virologist at the University of California, Irvine, and a member of the ARTIC network, spearheaded the creation of a mobile lab. The ARTIC network has a history of deploying sequencing tools in challenging environments, notably during the 2014 Ebola outbreaks in West Africa. The goal was to determine if portable sequencing could effectively chart HIV spread within Ukraine’s war-torn regions.

In August 2024, the team conducted a test run in Lviv, a city that has become a hub for internally displaced people fleeing the fighting. “We worked during the daytime… Most missile attacks happened at night,” Kovalenko explained, highlighting the precarious conditions under which the team operated. The experience underscored the challenges faced by healthcare workers in active conflict zones, who often have to abandon equipment and interrupt care during attacks.

New Evidence of Viral Evolution and Drug Resistance

During the Lviv test run, the team collected blood samples from 20 individuals living with HIV. To Kovalenko’s surprise, the analysis revealed a new HIV strain that emerged among displaced people after the escalation of the war in 2022. This finding provides direct genomic evidence of how conflict and displacement alter HIV transmission patterns. Crucially, the new strain carries a mutation suggesting resistance to a backup antiretroviral drug, raising concerns about the potential for broader drug resistance.

Casper Rokx, an HIV specialist at Erasmus MC in Rotterdam, Netherlands, who previously established stationary clinics in Lviv from 2023 to 2025, emphasized the advantage of the mobile lab. “We didn’t reach the hard-to-reach populations, at least not as effectively as we wanted that to be,” he stated. “Vans can just drive to where people are.”

Implications for Treatment and Surveillance

The discovery of drug resistance is particularly concerning. While the initial finding involves resistance to a backup drug, further sequencing of samples from displaced populations could reveal resistance to first-line treatments, a growing problem in other regions like South Africa. This underscores the urgent need for ongoing surveillance and adaptation of treatment strategies.

The team estimates, based on the rate of viral mutation, that the new HIV variant emerged after the full-scale Russian invasion began in 2022. This rapid evolution highlights the importance of continuous monitoring to understand how the virus is changing and to inform public health interventions.

Beyond HIV: Expanding the Scope of Mobile Labs

Kovalenko envisions expanding the use of the mobile laboratory to address other pressing health challenges exacerbated by the war. Antimicrobial resistance, particularly in soldiers with infected wounds, is a significant concern. Sequencing bacterial genomes could help clinicians prescribe appropriate antibiotics. Tuberculosis, another growing burden in Ukraine, often exhibits multi-drug resistance, making genomic sequencing even more critical.

What Comes Next: Strengthening Surveillance and Response

The success of this initial deployment signals a potential shift in how public health responses are conducted in conflict zones. The mobile lab model offers a flexible and adaptable approach to surveillance and research, allowing for rapid identification of emerging threats and informed decision-making. Further research is needed to refine the methodology and expand its reach, but the initial results are promising. Continued funding and collaboration will be essential to sustain this vital work and protect the health of vulnerable populations in Ukraine and beyond.

The team plans to continue sequencing samples and monitoring the evolution of HIV in Ukraine. This data will be shared with national and international health organizations to inform treatment guidelines and prevention strategies. The long-term goal is to establish a robust surveillance system that can detect and respond to emerging infectious disease threats in real-time.