The HIV epidemic in Constanta describes a unique pattern in the world. It has outbreak in 1986, in the pediatric population and it is of a monoclonal aspect, being determined by the F1 subtype. The evolution of the epidemic has known different stages in time: it spreads to the adult population, the transmission pathway becomes predominantly sexual and the circulating viral strains become diversified. The study proposes the characterization of the circulating HIV-1 subtypes in Constanta from the beginning of the epidemic to the present. The results indicate that subtype F1 remains dominant in patients from Constanta, mainly due to cases coming from the pediatric cohort that have now reached adulthood and are generating secondary cases through sexual transmission. As subtype B strains appeared sporadically before 1999, the strains C and B appear systematically after that moment in time. In 2004 the first subtype A strains were isolated. The year 2007 is the one with the highest biodiversity: along with the dominant subtype F1, subtypes C, A, B, G were isolated and also the circulating recombinant forms CRF02_02,

Impaired immunity induced by HIV is one of the main causes of disseminated histoplasmosis in endemic areas, and thus from 1987 WHO and then the CDC classified this condition as an AIDS-defining illness. Host factors associated independently with histoplasmosis are low level of CD4 (<150 cell/mm3) and CD8 count, low nadir CD4, male gender, the absence of cART, the absence of systemic antifungals, and history of herpes simplex infection. Dissemination of an exogenously new acquired infection or reinfection and reactivation of a latent infection are both described in HIV-infected patients. Also, inflammatory reconstitution disease following cART initiation is possible. Acute pulmonary infection is rare, and only in HIV-infected patients with CD4 > 200 cell/mm3. In advanced disease, the most frequent manifestation is as disseminated histoplasmosis often acute and severe, with complications such as respiratory failure, circulatory shock, and disseminated intravascular coagulation. The subacute presentation is frequent, associated with moderate involvement of the reticuloendothelial system, with great variability of clinical manifestation. Guidelines for diagnosing and managing histoplasmosis among people living with HIV have been published from WHO, IDSA, NIH, but limited data was based on randomized clinical trials.

Objective. To determine the prevalence of acquired drug resistance (ADR) and of resistance patterns in treatment-experienced HIV infected patients from Constanta in order to establish the best therapeutic options in NRTI class. Material and methods. A retrospective study which included 144 treatment-experienced HIV patients with confirmed viral failure. The strains isolated from these patients were analysed in the Molecular Genetic Laboratory of „Matei Bals“ National Institute of Infectious Diseases, Bucharest and the resulting sequences were saved in FASTA format. The HIV-1 subtyping was based on „REGA HIV01&2 Automated subtyping tool version 2.0“ algorithm. „Stanford HIVdb Program version 8.4“ was used in order to determine the therapeutic options. For statistical calculations, the R-Project software was used. Graphic representations were performed using GNUPLOT program. Results. The prevalence of the acquired drug resistance was 92.36%. The most frequent mutation occurred at the level of the codon 184. The TAM-2 path was more frequently selected compared to TAM-1. Association between TAM1 and TAM 2 were also found, mutation K65R being rarely met. Conclusions. The prevalence of the acquired drug resistance in our study was high, The most valuable therapeutic option in the INRT class remains tenofovir, due to the mutational profile, which was selected on account of the extensive use of thymidine analogues.

Obiective. Identificarea prevalenţei rezistenţei dobândite la INRT (inhibitorii non-nucleozidici de reverstranscriptază) şi al profilelor de rezistenţă la un lot de pacienţi cu multiple scheme de terapie antiretrovirală din Constanţa şi evaluarea opţiunilor terapeutice remanente. Material şi metode. Studiu retrospectiv ce a inclus 144 pacienţi seropozitivi HIV, multiplu experimentaţi terapeutic, aflaţi în eşec virusologic. Tulpinile izolate de la aceşti pacienţi au fost analizate în Laboratorul de Genetică Moleculară al Institutului Naţional de Boli Infecţioase „Matei Balş“ din Bucureşti, secvenţele rezultate fiind salvate în format Fasta. Subtiparea HIV-1 s-a efectuat pe baza algoritmului „REGA HIV-1&2 Automated subtyping tool version 2.0“. Pentru determinarea opţiunile terapeutice s-a utilizat „Stanford HIVdb Program version 8.4“. Datele au fost prelucrate statistic cu programul R-Project. Reprezentările grafice au fost realizate cu programul GNUPLOT. Rezultate. Prevalenţa rezistenţei dobândite a fost de 92,36%. Cea mai frecventă mutaţie a fost la nivelul codonului 184. Calea TAM-2 a fost mai frecvent selectată decât TAM-1, existând şi asociaţii între cele două căi; în schimb, mutaţia K65R a fost rar întâlnită. Concluzii. Prevalenţa rezistenţei dobândite la INRT a fost crescută. Opţiunea terapeutică cea mai valoroasă în clasa INRT a ramas tenofovirul, datorită profilului mutaţional selectat, mai ales din cauza neutilizării lui şi a folosirii extensive anterioare a analogilor timidinici.