Monophyletic HIV Type 1 CRF02-AG in a Nosocomial Outbreak in Benghazi, Libya

Abstract

A cluster of HIV-1 infection has been identified in Libya in 1999, involving 402 children admitted to "El-Fath" Children's Hospital in Benghazi (BCH) during 1998 and 19 of their mothers. Nosocomial transmission has been indicated as responsible for the spread of infection. Out of this group, 104 children and 19 adult women have been followed at the National Institute for Infectious Diseases L. Spallanzani in Rome during 1 year. At BCH, all children had received intravenous infusions but not blood or blood products. A single child receiving a blood transfusion in 1997 and the 17 infected mothers were never hospitalized in Benghazi. In addition, two nurses were diagnosed as HIV-1 infected. In 40 subjects out of this group HIV-1 gag, env, and pol fragments were amplified and sequenced. The phylogenetic analyses showed that a monophyletic recombinant HIV-1 form CRF02-AG was infecting all of the HIV-1-seropositive patients admitted at BCH with no close similarities to the other CRF02-AG reported to GenBank. A different strain was found in the child infected by blood transfusion. The data thus suggest a highly contagious nosocomial spread of HIV-1 infection and possibly transmission of the virus from child to mother during breastfeeding in connection with primary HIV-1 infection.

The Libyan HIV Outbreak How do we find the truth?

“…What is a statistical possibility that 500+ children carry the same monophyletic HIV-1 strain? Bear in mind that, according to all three scientific articles, it is a unique sequence that did not exist previously (CRF02-AG: [4][5][6]). What is the possibility that all the children carry the same monophyletic strain if the infection was initiated by a drug abuser at ElFatah children hospital and due to inappropriate infection control the contaminated needles were reused that spread HIV-1, HCV and HBV to more then 500 children?…”

“…It is becoming apparent from this discussion that it is very unlikely the virus originated from a single human being and spread to 500+ children in a short time period by the nosocomial infection, regardless of how inappropriate the infection control unit was. One can see this kind of scenario all over the developing nations and, yet, no one has encountered the kind of outbreak that is described in El-Fatah children hospital [3][4][5][6]. The alternate explanation is that the children were infected with two cloned HIV-1 viruses (first with an attenuated HIV-1 and then with a pathogenic strain of HIV-1).…”

“…d) From the above discussion it must be clear that if a single HIV-1 infected child was admitted a number of times within 1-2 years and he or she served as the index case, that individual would not be able to maintain the same viral subtype for that long and may transmit different quasispecies to different children [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. These subtypes will further recombine into the new hosts and therefore, it is highly unlikely that the virus will remain monophyletic [4][5][6].…”

Worldwide molecular epidemiology of HIV

“…This virus emerged among several African countries and became epidemic in the African continent, predominantly in West and West Central Africa, where it represents between 50 to 70% of the circulating strains. 2,24,38,83,91,109,143 Thus, from Africa CRF02_AG they were introduced in Europe and its epidemic has lately been rapidly spreading in France, 137 Belgium, 126 Italy, 90 and United Kingdom. 134 African and European immigrants are responsible by a large panel of CRFs in United Kingdom, such as CRF01_AE, CRF14_BG, CRF03_AB, CRF05_DF, CRF06_cpx, and CRF11_cpx, together with CRF02_AG and several URFs.…”

“…134 African and European immigrants are responsible by a large panel of CRFs in United Kingdom, such as CRF01_AE, CRF14_BG, CRF03_AB, CRF05_DF, CRF06_cpx, and CRF11_cpx, together with CRF02_AG and several URFs. 2,43,82,143 In China where circulates an Indian subtype C in addition to a Chinese subtype B variant (B Ch ), mainly among IDUs, the recombination of both viruses generated two new B/C recombinants, CRF07_BC and CRF08_BC. The CRF07_BC appears to contain two small subtype C segments interspersed with subtype B (a C/B/C configuration).…”