Evaluation of HIV-1 antiretroviral drug resistance profiles in the peripheral blood reservoir of successfully treated persons using massive sequencing and viral full genome characterization.

This article focuses on the genetic analysis of archived HIV-1 proviruses from people living with HIV (PLWH) under successful antiretroviral therapy (ART) in two Brazilian cities, Rio de Janeiro (RJ) and Rio Grande do Sul (RS). Using high-throughput sequencing (HTS) of near full-length genomes (NFLG), the study identified a predominance of HIV-1 subtype B in RJ and subtype C in RS, with a notable presence of recombinant forms. Drug resistance mutations (DRMs), including minority variants (mutations present at frequencies below 20%), were detected in 73.3% of samples, yet all patients maintained therapeutic success with undetectable viral loads. The findings highlight the prevalence of low- and high-frequency DRMs in archived proviruses without apparent impact on treatment efficacy, supporting the sustainability of combinatorial ART and underscoring the importance of monitoring minority variants in patients with controlled HIV infection.