Origin and spread of HIV-1 in persons who inject drugs in Bulgaria

Alexiev, Ivailo; Shankar, Anupama; Dimitrova, Reneta; Gancheva, Anna; Kostadinova, Asia; Teoharov, Pavel; Golkocheva, Elitsa; Nikolova, Maria; Muhtarova, Maria; Elenkov, Ivaylo; Stoycheva, Mariyana; Nikolova, Daniela; Varleva, Tonka; Switzer, William M.

doi:10.1016/j.meegid.2016.05.029

Cited by 15 publications

(30 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These findings contrast with the non-B infections in Bulgaria, which is composed mostly of PWIDs and heterosexual transmissions. Indeed, we previously reported that local, independent HIV-1 outbreaks were observed in PWID in two separate geographical regions of the country by two different recombinant forms of HIV-1, CRF01_AE, and CRF02_AG [16]. These CRF outbreaks in PWIDS resulted in major public health responses by the Bulgarian Ministry of Health, including HIV prevention and education campaigns, which significantly reduced HIV diagnoses in this vulnerable population.…”

Section: Discussionmentioning

confidence: 97%

“…Although the first case of subtype B infection in Bulgaria was diagnosed in a person who received a blood transfusion, subsequent diagnoses were mostly heterosexual transmission cases until 2006 when more diagnoses were found in MSM [14]. Subtype B infections have since increased significantly in MSM and HET with much lower prevalence in PWID and children born to infected mothers [16]. In 2018, 53.1% of new diagnoses were MSM compared to 34.7% HET, 11.3% PWID, and 1% vertical transmissions.…”

Section: Discussionmentioning

confidence: 99%

“…The HIV-1 protease and reverse transcriptase regions of the pol gene was sequenced using the ViroSeq HIV-1 Genotyping Test (Abbott, Chicago, IL, USA) and/or TruGene DNA Sequencing System (Siemens Medical Solutions Diagnostics, Germany) and either the Applied Biosystems 3130xl genetic analyzer or an OpenGene DNA sequencing system following the manufacturer's protocol [16].…”

Section: Data Set and Sequence Analysesmentioning

confidence: 99%

“…The HIV-1 epidemic in Bulgaria has been affected by various historic and socio-economic factors. Multiple HIV-1 subtypes and recombinant forms have been introduced from various countries of the world and subsequently disseminated unequally among individuals from different transmission groups, including heterosexual (HET) persons, men who have sex with men (MSM), and persons who inject drugs (PWID) [11][12][13][14][15][16]. Due to random founder events, certain HIV-1 strains have spread rapidly after being introduced into high risk groups and then expanded into transmission clusters, representing local outbreaks.…”

Section: Introductionmentioning

confidence: 99%

“…Due to random founder events, certain HIV-1 strains have spread rapidly after being introduced into high risk groups and then expanded into transmission clusters, representing local outbreaks. Indeed, such events were observed since 2005 when two different CRFs (CRF01_AE and CRF02_AG) have been independently introduced and rapidly disseminated among two geographically distinct subgroups of PWID, resulting in local outbreaks [12,16].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Molecular Epidemiology of the HIV-1 Subtype B Sub-Epidemic in Bulgaria

Alexiev

Campbell

Knyazev

et al. 2020

Viruses

Self Cite

View full text Add to dashboard Cite

HIV-1 subtype B is the predominant strain in Bulgaria, yet little is known about the molecular epidemiology of these infections, including its origin and transmissibility. We used a phylodynamics approach by combining and analyzing 663 HIV-1 polymerase (pol) sequences collected from persons diagnosed with HIV/AIDS between 1988–2018 and associated epidemiologic data to better understand this sub-epidemic in Bulgaria. Using network analyses at a 1.5% genetic distance threshold (d) we found several large phylogenetic clusters composed mostly of men who have sex with men (MSM) and male heterosexuals (HET). However, at d = 0.5%, used to identify more recent transmission, the largest clusters dissociated to become smaller in size. The majority of female HET and persons with other transmission risks were singletons or pairs in the network. Phylogenetic analysis of the Bulgarian pol sequences with publicly available global sequences showed that subtype B was likely introduced into Bulgaria from multiple countries, including Israel and several European countries. Our findings indicate that subtype B was introduced into Bulgaria multiple times since 1988 and then infections rapidly spread among MSM and non-disclosed MSM. These high-risk behaviors continue to spread subtype B infection in Bulgaria as evidenced by the large clusters at d = 0.5%. Relatively low levels of antiretroviral drug resistance were observed in our study. Prevention strategies should continue to include increased testing and linkage to care and treatment, as well as expanded outreach to the MSM communities.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Data Set and Sequence Analysesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Molecular Epidemiology of the HIV-1 Subtype B Sub-Epidemic in Bulgaria

Alexiev

Campbell

Knyazev

et al. 2020

Viruses

Self Cite

View full text Add to dashboard Cite

show abstract

Origin and Spread of HIV-1 Subtype B Among Heterosexual Individuals in Bulgaria

Alexiev

Presti

Dimitrova

et al. 2018

AIDS Research and Human Retroviruses

View full text Add to dashboard Cite

Human immunodeficiency virus (HIV) was originally introduced in Bulgaria through heterosexual transmission (HET) and later transferred to other vulnerable groups along with numerous more recent introductions from outside Bulgaria. To define the diversity, origins, and dynamics of the HIV-1 subtypes prevalent in HET population in Bulgaria, we applied phylogenetic and phylodynamic analyses using polymerase (pol) sequences from HET individuals to infer the spatiotemporal evolutionary history of the HIV-1 epidemic in this population in Bulgaria. High genetic diversity was found, including 13 different HIV-1 subtypes: 45.7% subtype B, 19.9% CRF01_AE, 7.5% CRF02_AG, 7.5% sub-subtypes A1 and A6, 7.1% subtype C, 5.3% subtype F1, 4.0% URFs, 1.2% CRF05_DF, 0.6% subtype G, 0.3% CRF04_cpx, 0.3% CRF29_BF, 0.3% CRF14_BG, and 0.3% subtype H. The estimated root of the subtype B in the phylogenetic tree dated back to the year 1980 largely due to multiple introductions of subtype B from outside the country. Several significant clades have been identified highlighting six different main epidemic entrances of subtype B dating from 1989 to 2007. The Bayesian skyline plot showed two different exponential growth periods starting in the 1980s to 1990 followed by a constant phase up to about 2008, with another exponential growth period from 2008 to the year 2012. The migration analysis identified dynamic pattern of gene flow and demonstrated that many HET probably acquired the infection abroad (14.6%), while only (6.6%) of non-HET were infected outside country. The phylogenetic analysis showed an intermixing between sequences from Bulgarians with sequences from other countries, suggesting different HIV introduction in this country followed by the internal spread through local transmission networks.

show abstract

Prevalence and burden of HBV co‐infection among people living with HIV: A global systematic review and meta‐analysis

Platt

French

McGowan

et al. 2019

Journal of Viral Hepatitis

View full text Add to dashboard Cite

Globally, in 2017 35 million people were living with HIV (PLHIV) and 257 million had chronic HBV infection (HBsAg positive). The extent of HIV‐HBsAg co‐infection is unknown. We undertook a systematic review to estimate the global burden of HBsAg co‐infection in PLHIV. We searched MEDLINE, Embase and other databases for published studies (2002‐2018) measuring prevalence of HBsAg among PLHIV. The review was registered with PROSPERO (#CRD42019123388). Populations were categorized by HIV‐exposure category. The global burden of co‐infection was estimated by applying regional co‐infection prevalence estimates to UNAIDS estimates of PLHIV. We conducted a meta‐analysis to estimate the odds of HBsAg among PLHIV compared to HIV‐negative individuals. We identified 506 estimates (475 studies) of HIV‐HBsAg co‐infection prevalence from 80/195 (41.0%) countries. Globally, the prevalence of HIV‐HBsAg co‐infection is 7.6% (IQR 5.6%‐12.1%) in PLHIV, or 2.7 million HIV‐HBsAg co‐infections (IQR 2.0‐4.2). The greatest burden (69% of cases; 1.9 million) is in sub‐Saharan Africa. Globally, there was little difference in prevalence of HIV‐HBsAg co‐infection by population group (approximately 6%‐7%), but it was slightly higher among people who inject drugs (11.8% IQR 6.0%‐16.9%). Odds of HBsAg infection were 1.4 times higher among PLHIV compared to HIV‐negative individuals. There is therefore, a high global burden of HIV‐HBsAg co‐infection, especially in sub‐Saharan Africa. Key prevention strategies include infant HBV vaccination, including a timely birth‐dose. Findings also highlight the importance of targeting PLHIV, especially high‐risk groups for testing, catch‐up HBV vaccination and other preventative interventions. The global scale‐up of antiretroviral therapy (ART) for PLHIV using a tenofovir‐based ART regimen provides an opportunity to simultaneously treat those with HBV co‐infection, and in pregnant women to also reduce mother‐to‐child transmission of HBV alongside HIV.

show abstract

Origin and spread of HIV-1 in persons who inject drugs in Bulgaria

Cited by 15 publications

References 27 publications

Molecular Epidemiology of the HIV-1 Subtype B Sub-Epidemic in Bulgaria

Molecular Epidemiology of the HIV-1 Subtype B Sub-Epidemic in Bulgaria

Origin and Spread of HIV-1 Subtype B Among Heterosexual Individuals in Bulgaria

Prevalence and burden of HBV co‐infection among people living with HIV: A global systematic review and meta‐analysis

Contact Info

Product

Resources

About