Abstract
Abstract
The HIV epidemic among men who have sex with men (MSM) in Europe is sustained by structured transmission networks in which drug resistance mutations (DRMs) spread across geopolitical boundaries. Herein, we applied a systematic molecular epidemiological framework to characterise DRM prevalence, temporal trends, and identify transmission clusters from MSM across European geopolitical regions (Western Europe, Central and Eastern Europe, Southern Europe, and Northern Europe). This was a retrospective molecular epidemiological analysis conducted with 3300 HIV
pol
sequences from 1983 to 2016. Sequences were aligned with ViralMSA, the maximum likelihood (ML) tree was reconstructed with IQ-TREE, the transmission cluster was inferred with ClusterPicker, and HIVDR was evaluated with Stanford HIVdb. An overall DRM prevalence of 28% (95% CI: 26.5–29.5%) was detected, with NRTIs as the dominant drug class affected (12.8%). A significant decreasing temporal trend was detected (Mann–Kendall τ = − 0.52,
p
p
< 0.001). These findings reveal that resistant variants are actively clustering and spreading across European borders, underscoring the need for coordinated multi-regional molecular surveillance.