The global spread of HIV-1 subtype B epidemic

Magiorkinis, Gkikas; Angelis, Konstantinos; Mamais, Ioannis; Katzourakis, Aris; Hatzakis, Angelos; Albert, Jan; Lawyer, Glenn; Hamouda, Osamah; Struck, Daniel; Vercauteren, Jürgen; Wensing, Annemarie; Alexiev, Ivailo; Åsjö, Birgitta; Balotta, Claudia; Gómes, Perpétua; Camacho, Ricardo Jorge; Coughlan, Suzie; Griskevicius, Algirdas; Grossman, Zehava; Horban, Anders; Kostrikis, Leondios G.; Lepej, Snjezana J; Liitsola, Kirsi; Linka, Marek; Nielsen, Claus Henrik; Oțelea, Dan; Paredes, Roger; Poljak, Mario; Puchhammer-Stöckl, Elizabeth; Schmit, Jean Claude; Sönnerborg, Anders; Staneková, Danica; Stanojević, Maja; Stylianou, Dora C.; Boucher, Charles A.; Nikolopoulos, Georgios K.; Vasylyeva, Tetyana I.; Friedman, Samuel R.; Vijver, David van de; Angarano, Gioacchino; Chaix, Marie‐Laure; Luca, Andrea De; Korn, Klaus; Loveday, Clive; Soriano, Vincent; Yerly, Sabine; Zazzi, Maurizio; Vandamme, Anne‐Mieke; Paraskevis, Dimitrios

doi:10.1016/j.meegid.2016.05.041

Cited by 46 publications

(40 citation statements)

References 45 publications

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“…Subtype C is the most abundant strain worldwide and is prevalent in South and Eastern Africa and South East Asia [2]. Subtype B is predominant in North America, Western Europe, and Australia, while subtype A predominates in Eastern Europe and central Asia, including Russia [2,7]. CRFs and URFs are widely distributed in central Africa and in countries where different subtypes co-circulate [2,8,9].…”

Section: Introductionmentioning

confidence: 99%

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

Alexiev

Campbell

Knyazev

et al. 2020

Viruses

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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.

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Section: Introductionmentioning

confidence: 99%

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

Alexiev

Campbell

Knyazev

et al. 2020

Viruses

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“…HIV-1 genetic heterogeneity leads to the establishment of an increasing number of subtypes, sub-subtypes and Circulating Recombinant Forms (CRFs), which have a specific geographic distribution that, however, is continuously evolving because of travelling and migration 8 . These genetic forms can be transmitted with different efficiency 9,10 and have different sensitivity to ART 11 .…”

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High HIV-1 diversity in immigrants resident in Italy (2008–2017)

Maggiorella

Sanarico

Brindicci

et al. 2020

Sci Rep

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The proportion of new diagnoses of HIV infection in immigrants residing in Italy raised from 11% in 1992 to 29.7% in 2018. To investigate the HIV clades circulating in this community a retrospective study was performed in 557 HIV-infected immigrants living in 12 Italian cities. Immigrants originated from East-Europe and Central-Asia (11.7%), North Africa and Middle East (7.3%), South and SouthEast Asia (7.2%), Latin America and the Caribbean (14.4%), and sub-Saharan Africa (59.4%). More than 87% of immigrants were on antiretroviral therapy (ART), although 26.6% of them were viremic. A 22.0% of immigrants had hepatitis (HBV and/or HCV) and/or tuberculosis. HIV phylogenetic analysis on sequences from 192 immigrants showed the presence of clades B (23.4%), G (16.1%), C (10.4%), A1 (9.4%), F1 (5.2%), D (1.6%) and Circulating Recombinant Forms (CRFs) (33.9%). CRF02_AG represented 72.3% of the total CRFs. Clusters between immigrants and Italian natives were also present. Drug resistance mutations to NRTI, NNRTI, and PI drug classes occurred in 29.1% of ART-treated and in 12.9% of ART-naïve individuals. These data highlight the need for tailored public health interventions in immigrants to avoid spreading in Italy of HIV genetic forms and ART-resistant variants, as well as HIV co-morbidities.

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“…Although the HIV-1 epidemic in Western African countries (Cameroon and Senegal) is clearly more divergent, subtype A (or its recombinants) is also one of the most abundant subtypes in many of these countries (10). A large epidemic of an HIV-1 subtype A variant is also seen in Eastern Europe, particularly in the Former Soviet Union (FSU) area (12)(13)(14)(15). This subepidemic strain, here termed the Eastern European lineage or A Former Soviet Union (A FSU ), is estimated to have arrived in the town of Odessa (Ukraine) around 1984 from the DRC, and since 1993, it has spread explosively among people who inject drugs (PWID) all over the Former Soviet Union (13).…”

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Reconstruction of the Genetic History and the Current Spread of HIV-1 Subtype A in Germany

Hanke

Faria

Kühnert

et al. 2019

J Virol

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HIV-1 non-B infections have been increasing in Europe for several years. In Germany, subtype A belongs to the most abundant non-B subtypes showing an increasing prevalence of 8.3% among new infections in 2016. Here we trace the origin and examine the current spread of the German HIV-1 subtype A epidemic. Bayesian coalescence and birth-death analyses were performed with 180 German HIV-1 pol sequences and 528 related and publicly available sequences to reconstruct the population dynamics and fluctuations for each of the transmission groups. Our reconstructions indicate two distinct sources of the German subtype A epidemic, with an Eastern European and an Eastern African lineage both cocirculating in the country. A total of 13 German-origin clusters were identified; among these, 6 clusters showed recent activity. Introductions leading to further countrywide spread originated predominantly from Eastern Africa when introduced before 2005. Since 2005, however, spreading introductions have occurred exclusively within the Eastern European clade. Moreover, we observed changes in the main route of subtype A transmission. The beginning of the German epidemic (1985 to 1995) was dominated by heterosexual transmission of the Eastern African lineage. Since 2005, transmissions among German men who have sex with men (MSM) have been increasing and have been associated with the Eastern European lineage. Infections among people who inject drugs dominated between 1998 and 2005. Our findings on HIV-1 subtype A infections provide new insights into the spread of this virus and extend the understanding of the HIV epidemic in Germany. IMPORTANCE HIV-1 subtype A is the second most prevalent subtype worldwide, with a high prevalence in Eastern Africa and Eastern Europe. However, an increase of non-B infections, including subtype A infections, has been observed in Germany and other European countries. There has simultaneously been an increased flow of refugees into Europe and especially into Germany, raising the question of whether the surge in non-B infections resulted from this increased immigration or whether German transmission chains are mainly involved. This study is the first comprehensive subtype A study from a western European country analyzing in detail its phylogenetic origin, the impact of various transmission routes, and its current spread. The results and conclusions presented provide new and substantial insights for virologists, epidemiologists, and the general public health sector. In this regard, they should be useful to those authorities responsible for developing public health intervention strategies to combat the further spread of HIV/AIDS.

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The global spread of HIV-1 subtype B epidemic

Cited by 46 publications

References 45 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

High HIV-1 diversity in immigrants resident in Italy (2008–2017)

Reconstruction of the Genetic History and the Current Spread of HIV-1 Subtype A in Germany

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