HIV‐1 subtype frequency in Northeast Brazil: A systematic review and meta‐analysis

Abstract

Information on human immunodeficiency virus (HIV) molecular epidemiology is required to verify HIV/AIDS (acquired immune deficiency syndrome) epidemic dynamics in different regions, as well as provide support for response to antiretroviral therapy, transmission of resistance mutations, disease progression, and viral spread. The aim of this study was to conduct a systematic review and meta‐analysis of the frequency of HIV‐1 subtypes in Northeast Brazil. Seventy‐six articles that refer to HIV‐1 and its subtypes in the Northeast Brazil and published between 1 January 1999 and 31 August 2019 were identified. We included 27 articles for the qualitative synthesis, thus analyzing results from 4466 patients and 4298 genomic sequences. The results showed that subtypes B, F, and C and recombinant BF were responsible for 76% (IC95%: 71‐80), 8% (IC95%: 5‐11), 2% (IC95%: 2‐3), and 7% (IC95%: 4‐12) infections, respectively. The highest proportion of subtype B infections (82.2%) was observed in Piauí, while the subtype F had a high frequency in Pernambuco (23.4%). Bahia presented 11.6% of the proportion of recombinant BF. In addition, several recombinants such as AG, BC, BCF, and BD have been identified in the region. This is the first systematic review and meta‐analysis on the HIV‐1 subtype distribution in Northeast Brazil and has shown a high circulating viral diversity. Although subtype B is predominant in Brazil, a large frequency of non‐B subtypes has also been found, which may have consequences for response to antiretroviral therapy, disease progression, and transmission. Thus, HIV molecular epidemiological data are essential for epidemic prevention and control strategies.

HIV‐1 subtypes and drug resistance in children during antiretroviral therapy in Brazil

“…However, currently, subtype C and BF recombinants have been dispersed throughout the country 21 . Also, in the northeastern region of Brazil, where this study was conducted, there has been an increase in the prevalence of BF recombinants and low frequencies of BC recombinants 18 . No difference was observed between the frequency of antiretroviral resistance mutations and HIV‐1 subtypes.…”

“…21 Also, in the northeastern region of Brazil, where this study was conducted, there has been an increase in the prevalence of BF recombinants and low frequencies of BC recombinants. 18 No difference was observed between the frequency of antiretroviral resistance mutations and HIV-1 subtypes. However, the low number of samplings of non-B subtypes is a limitation in this analysis.…”

“…We found that in children and adolescents infected with HIV‐1, the circulation of different subtypes and recombinants were observed, predominantly subtype B (84.8%) and BF recombinants (9.8%). BF recombinants showed large differences in the recombination patterns of genomic segments B and F; however, three strains showed partial similarity with recombinants 28 and 29 BF, which are widely distributed in Brazil 18–20 . In Brazil, the HIV‐1 molecular epidemiology has revealed higher frequencies of subtypes B, F, and C. However, HIV‐1 C is more prevalent in the southern region of the country 21 .…”

“…BF recombinants showed large differences in the recombination patterns of genomic segments B and F; however, three strains showed partial similarity with recombinants 28 and 29 BF, which are widely distributed in Brazil. [18][19][20] In Brazil, the HIV-1 molecular epidemiology has revealed higher frequencies of subtypes B, F, and C. However, HIV-1 C is more prevalent in the southern region of the country. 21 Despite the HIV-1 subtypes having different origins and introductions in Brazil, subtype B showed greater dispersion, which is explained by the longer time of introduction.…”

The Epidemiological Impact of STIs among General and Vulnerable Populations of the Amazon Region of Brazil: 30 years of Surveillance

“…Four groups have already been identified (M, N, O and P), nine subtypes (A, B, C, D, F, G, H, J and K), a circulating recombinant form (CRF) and unique recombinant forms (URFs) [ 23 ]. In Brazil, subtypes B and F predominate, followed by subtype C and recombinant BF [ 24 , 25 ], except in the southern region, where subtype C is more common than subtype F [ 26 ]. In the northern region, subtype B is the most prevalent, and the state of Pará is an important gateway for entry of the virus into the region [ 27 ].…”