During 2011-2016, HIV outbreaks occurred among people who inject drugs (PWID) in

Since 2011, Romania has faced an HIV outbreak among injecting drug users (IDUs). Our aim was to identify and describe clinical and epidemiological patterns of this outbreak. A cross-sectional study enrolled 138 IDUs diagnosed with HIV infection between 2011 and 2013 with 58 sexually infected individuals included as the control group. The IDUs had a long history of heroin abuse (10 years) and a recent history of new psychostimulant injection (3-4 years). Classical epidemiological data and molecular techniques were used to describe the transmission dynamics. A high prevalence of hepatitis C virus (HCV) coinfection was noted (98.6%) compared to the control group (10.3%) ( p < 0.001). IDUs had initially been infected with HCV. HIV infection was more recent, linked to starting injecting stimulants. HIV subtype analysis showed a predominance of the local F1 strain in both IDUs and sexually infected patients; in IDUs it also identified 28 CRF14_BG recombinants and six unique recombinant forms (URFs) between F1 and CRF14_BG. A few patients from both risk groups were infected with subtype B. Among IDUs, CRF14_BG was associated with a lower CD4 cell count and more advanced stages of disease, which correlated with CXCR4 tropism. Phylogenetic analysis revealed the spread of HIV through three major IDU clusters of recent date. Among IDUs with CRF14_BG, some reported travel abroad (Spain, Greece). By identifying clusters of IDUs with related viruses, molecular epidemiologic methods provide valuable information on patterns of HIV transmission that can be useful in planning appropriate harm reduction interventions.

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Co-infections with HIV and HCV are very frequent among people who inject drugs (PWID). However, very few studies comparatively reconstructed the transmission patterns of both viruses in the same population. We have recruited 117 co-infected PWID during a recent HIV outbreak in Romania. Phylogenetic analyses were performed on HIV and HCV sequences in order to characterize and compare transmission dynamics of the two viruses. Three large HIV clusters (2 subtype F1 and one CRF14_BG) and thirteen smaller HCV transmission networks (genotypes 1a, 1b, 3a, 4a and 4d) were identified. Eighty (65%) patients were both in HIV and HCV transmission chains and 70 of those shared the same HIV and HCV cluster with at least one other patient. Molecular clock analysis indicated that all identified HIV clusters originated around 2006, while the origin of the different HCV clusters ranged between 1980 (genotype 1b) and 2011 (genotypes 3a and 4d). HCV infection preceded HIV infection in 80.3% of cases. Coincidental transmission of HIV and HCV was estimated to be rather low (19.65%) and associated with an outbreak among PWID during detention in the same penitentiary. This study has reconstructed and compared the dispersion of these two viruses in a PWID population.

Aims: We aimed to quantify global and regional body composition changes in chronic hepatitis C (CHC) patients, compare them to healthy controls and identify possible association between body composition changes and CHC. To our knowledge, this study is the first one comparing CHC patients to controls with regard to soft tissue body composition changes. Methods: We assessed 60 CHC patients and 60 healthy controls by Dual Energy X-Ray Absorptiometry. Soft tissue and bone body composition parameters were compared between the groups (using the Mann-Whitney test). These parameters were correlated (using Spearman’s rank correlation coefficient – rho) with independent variables (age, gender, body mass index – BMI, cigarette smoking, time since CHC diagnosis, viral load, fibrosis grade, type of treatment, time of treatment) for the entire CHC group and also for subgroups according to gender. Results: Total fat mass, trunk fat mass and percent body fat were lower in CHC patients as compared to controls. Several risk factors were associated with the reduced fat mass: low BMI, cigarette smoking and peginterferon alpha 2a plus ribavirin treatment. Peginterferon alpha 2a and ribavirin treatment negatively correlated with lean body parameters, especially in CHC males group. Bone mineral density (BMD) was lower as compared to controls and was correlated with low BMI, cigarette smoking and peginterferon alpha 2a and ribavirin treatment. Conclusions: Patients with CHC have an acquired type of lipodystrophy (particularly in the trunk region), and also a reduced BMD as compared with controls. A low BMI, cigarette smoking and peginterferon alpha 2a and ribavirin therapy were associatd with a low fat mass and low BMD. Abbreviations: BMD: bone mineral density; BMI: body mass index; CHC: chronic hepatitis C; DXA: Dual Energy X ray Absorptiometry; FM: fat mass; FMR: fat mass ratio; HCADS: hepatitis C associated dysmetabolic syndrome; HCV: hepatitis C virus; HO: hepatic osteodystrophy; LS: lumbar spine; LM: lean mass; PBF: percent body fat.