HIV Spread in Ukraine: Mobile Lab Tracks War’s Hidden Impact

The ongoing war in Ukraine has severely disrupted healthcare services, creating conditions ripe for the spread of infectious diseases. Now, a mobile laboratory is bringing advanced diagnostic capabilities directly to the front lines, revealing a concerning trend: the emergence of drug-resistant HIV strains.

HIV has been present in Ukraine since the 1990s, primarily spread through intravenous drug use, but also through sexual contact. The Russian invasion, beginning with the annexation of Crimea in 2014 and escalating significantly in 2022, has dramatically worsened the situation. Access to essential services like HIV testing, treatment, and preventative measures – including needle exchange programs – has been drastically reduced, particularly for the millions of Ukrainians displaced by the conflict.

Traditionally, monitoring HIV spread has relied on stationary clinics and laboratories, often located far from areas of active conflict or high displacement. This logistical challenge hindered efforts to track the virus’s evolution and identify emerging drug resistance. Clinicians haven’t routinely sequenced virus genomes to look for concerning mutations, a practice limited by the distance to specialized labs.

To address this gap, virologist Ganna Kovalenko, of the University of California, Irvine, and her team developed a mobile laboratory housed within a van. Inspired by the work of the ARTIC network – an organization that brought sequencing tools to remote areas during the 2014 Ebola outbreaks in West Africa – Kovalenko sought to apply this model to the Ukrainian crisis. “I wondered whether portable sequencing tools could prove fruitful in other emergency scenarios, such as charting HIV spread across Ukraine,” she explained.

In August 2024, the team conducted a test run in Lviv, a relatively safe haven for displaced people in western Ukraine. Working during the day, mindful of nighttime missile attacks, they collected blood samples from 20 individuals living with HIV. Kovalenko initially anticipated the small sample size wouldn’t yield significant findings, hoping only to demonstrate the feasibility of the mobile lab. However, the results proved surprisingly revealing.

The researchers discovered a new strain of HIV that had emerged among displaced people in Lviv after the escalation of the war in 2022. Published in the journal AIDS, the findings provide direct evidence of how war and displacement can alter HIV transmission patterns. By comparing the genome of this new strain to samples taken in 2020, the team estimated, based on the virus’s mutation rate, that the variant arose after the broader Russian invasion began.

More concerningly, the new strain carried a mutation in a gene that conferred resistance to a backup antiretroviral drug. This discovery raises the possibility that further sequencing of samples from displaced populations could reveal resistance to first-line HIV treatments. “That’s not as hypothetical as we first thought it would be,” said Casper Rokx, an HIV specialist at Erasmus MC in Rotterdam, Netherlands, who previously established stationary HIV clinics in Lviv from 2023 to 2025. He noted that drug resistance against first-line treatments is already a growing problem in other regions, such as South Africa.

Rokx emphasized the limitations of relying solely on stationary clinics. “We didn’t reach the hard-to-reach populations, at least not as effectively as we wanted to be,” he said. The mobile lab, in contrast, offers the flexibility to “just drive to where people are.”

The implications extend beyond HIV. Kovalenko envisions utilizing the mobile lab to address other pressing health challenges exacerbated by the war. “Antimicrobial resistance is one of the most urgent problems on the frontlines,” she stated, where soldiers frequently develop infected wounds. Sequencing bacterial genomes could help clinicians prescribe the most effective antibiotics. Both Kovalenko and Rokx also highlighted the increasing burden of tuberculosis in Ukraine, often caused by drug-resistant strains.

The mobile laboratory represents a proactive response to a complex public health crisis. As Rokx put it, “I think what they nicely did was bring deep sequencing and advanced laboratory technique to a population in need.” The van’s ability to pierce through the “fog” of war and provide critical data on HIV evolution and drug resistance offers a vital tool in protecting the health of Ukrainians affected by the ongoing conflict.