The invasion of Ukraine has stymied healthcare services, allowing diseases such as HIV to spread unchecked. The rate of contagion has been difficult to gauge. But now, using a van equipped with portable research gear, virologist Ganna (Anna) Kovalenko is probing the hidden threat that HIV poses in the war-torn country.
HIV has been spreading in Ukraine since the 1990s, mainly through intravenous drug use but also sexual activity, says Kovalenko, of the University of California, Irvine. The Russian invasion of Crimea in 2014 and the expanded siege beginning in 2022 have exacerbated the problem by reducing access to testing, treatment and preventative measures, such as needle exchange programs.
Even when testing is available, clinicians don’t routinely sequence virus genomes to look for concerning mutations, such as ones that lead to drug resistance. This is partly because sequencing is normally tied to laboratories, often located far from virus hotspots.
That’s where a project called the ARTIC network comes in. It aims to bring sequencing tools to remote or inaccessible places, such as during the 2014 Ebola outbreaks in West Africa. Kovalenko, who is part of the network, wondered whether portable sequencing tools could prove fruitful in other emergency scenarios, such as charting HIV spread across Ukraine.
So she and her team decided to build a lab in a van.
On a test run in August 2024, Kovalenko and her colleagues drove to Lviv, a relatively safe hub in western Ukraine for displaced people that migrated away from the front lines. “We worked during the daytime. Most missile attacks happened at night,” she says. Over three days in the van, many local healthcare workers she met along the way shared with her their frustrations about the conflict.
“They describe situations where missile attacks start during the day while they are providing care, and they had to react immediately, leaving everything behind and driving away as fast as possible,” she says. The healthcare workers couldn’t escape without parting ways with their lab equipment.
Previously, only stationary clinics had been used to monitor HIV spread. Medical doctor Casper Rokx, for example, set up stationary clinics in Lviv to provide HIV care from 2023 to 2025. “We didn’t reach the hard-to-reach populations, at least not as effectively as we wanted that to be,” says Rokx, an HIV specialist at Erasmus MC in Rotterdam, Netherlands. In contrast, “vans can just drive to where people are.”
During their test drive, Kovalenko’s team sampled blood from 20 HIV-positive people. Kovalenko assumed they wouldn’t find anything interesting with such a small pool of participants, expecting only to demonstrate that the van showed promise. Instead, the researchers discovered an HIV strain that had emerged among displaced people in Lviv after the expanded war began, the team reported in the journal AIDS.
“It gives us direct evidence that war and displacement change how HIV spreads,” Kovalenko says. By comparing the genome of this strain to other HIV genomes sequenced in 2020, the researchers estimate, based on how quickly the virus mutates, that the new variety emerged after the Russian invasion expanded in 2022.
They also discovered a mutation in a virus gene that rendered it resistant to a backup antiretroviral drug, which sounds alarm bells. Should the team sequence HIV from more displaced people in the future, they may discover other resistance mutations against first-line drugs. “That’s not as hypothetical as we first thought it would be,” Rokx says. Scientists found drug resistance against first-line HIV treatments is a growing problem elsewhere, such as South Africa, he notes.
Down the road, Kovalenko would like to explore other applications of their mobile laboratory. “Antimicrobial resistance is one of the most urgent problems on the frontlines,” where soldiers often develop infected wounds, she says, so sequencing bacterial genomes could help clinicians prescribe appropriate antibiotics. Both Kovalenko and Rokx note that tuberculosis is another growing burden in Ukraine, and the bacteria behind this disease are often resistant to multiple drugs.
War has provided a smokescreen for HIV to spread and mutate, but this van could help researchers pierce through that fog. “I think what they nicely did was bring deep sequencing and advanced laboratory technique to a population in need,” Rokx says.
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