The Prevalence of Hiv Recombinant Forms in Russia and Countries of the Cis: Systematic Review and Metaanalysis

Abstract

This review was to aimed to access the prevalence of HIV recombinant forms in Russia and countries of the CIS, which have close social and economic ties. We conducted a search in Russian Science Citation Index and PubMed for a depth of 8 years. We included 22 articles, which contained the results of 35 independent cross-sectional studies, in our review. Meta-analysis of HIV recombinant forms prevalence was conducted in Open Meta-analyst with the use of Der Simonian & Laird method, arcsin transformation and correction factor for zero values. Subgroup analysis was used along with meta-regression (by date of collection). Pooled prevalence of HIV recombinant forms was 21.3% (95% CI 16.2–26.5) and was highly heterogeneous. Blood samples from 3,494 HIV patients living in various regions of the Russian Federation and CIS countries — Belarus, Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan, Armenia, Georgia — were examined. Among subtypes of HIV-1, the main share was occupied by subtype A — 75.6% (n = 2643), subtype B — 5.5% (n = 193), C — 0.8% (n = 31), G — 0.2% (n = 7), F — 0.14% (n = 5). Among the recombinant forms (n = 616), the fraction of CRF02_ AG was 39.6% (n = 244), CRF02_AG/A was 32.9% (n = 203), CRF63_02A1 was 15.9% (n = 98), CRF03_AB — 5.2% (n = 32), CRF06_cpx — 2.1% (n = 13). Unique recombinant forms were 2.7% (n = 17), including URF63_A1 (2.5%). In Russia, the highest prevalence of recombinant forms of HIV-1 was registered in the Siberian Federal District (33.2% (95% CI 12.2– 54.1), the lowest in the Northwest Federal District — 1.6% (95% CI 0.9–2.3). In the CIS countries, the highest prevalence of recombinant forms of HIV-1 is found in a subgroup of the Central Asian republics — Uzbekistan, Tajikistan, Kyrgyzstan, Kazakhstan — 51.7% (95% CI 38.5–64.9). The significant upward trend was shown with a meta-regression. Our review is the first such research in Russia and thus is of significant interest, but the result should be applied with caution due to high risk of publication bias as well as significant heterogeneity of our results.

Prevalence and spatiotemporal dynamics of HIV-1 Circulating Recombinant Form 03_AB (CRF03_AB) in the Former Soviet Union countries

“…This review showed that the pooled prevalence of HIV-1 CRF03_AB recombinant in northwestern FSU countries, including the Northwestern federal district of Russia, accounts to nearly about a tenth of all HIV-infections (9.9%), with clear geographical differences between the countries; this figure is higher than our previous estimate of about 5.2% [ 38 ]. Nonetheless, compared to that study (only partially overlapping with the present one), this analysis incorporated more eligible articles, including all studies in the systematic review [ 38 ] as well as additional studies published from 1998 to 2010 and 2018 to 2020; hence, up-to-date information and extended list of studies is critical.…”

“…The prevalence of different HIV-1 subtypes have experienced a tremendous change in the FSU region and the present epidemic here is predominantly driven by heterosexual practice [ 8 ]. In recent decade, the epidemic evolved with an increase both in the incidence and prevalence of HIV-1 non-A6 subtypes, primarily recombinant forms [ 38 ]. Hence, recombinant forms spread are becoming a serious public health challenge, which requires a deeper understanding of their origin and distribution.…”

“…The meta-analysis of HIV-1 CRF03_AB recombinant prevalence was conducted in Open Meta-analyst (accessible at http://www.cebm.brown.edu/openmeta/ ) using the Der Simonian & Laird method, arcs in transformation and correction factor (+0,5) for zero values as described elsewhere [ 38 ]. The heterogeneity of results between studies was evaluated using I 2 statistic; heterogeneity was considered high at I 2 values greater than 75.0%.…”

“…A recent meta-analysis of all published HIV-1 subtyping data in FSU countries [ 38 ] showed that subtype A6 is still responsible for almost three quarters (75.6%) of HIV-1 infections. The prevalence of HIV-1 A6 subtype is the highest, accounting for 70.0–99 90.0% of infections in Russia, Ukraine, Belarus, Latvia and Armenia [ 37 , 39 – 41 ].…”

“…HIV-1 CRFs accounts for about 17.6% of infections with the highest prevalence in Central Asian countries, where 51.7% of all HIV-infection cases caused by recombinants are observed. During the last few years, AG recombinants (CRF02_AG/CRF63_02A1) had quickly overtaken A6 subtype in Central Asia and Russian Siberian region and to date determines the HIV-1 epidemic there (88.4% of all recombinants) [ 30 , 38 ]. In contrast, the HIV-1 CRF03_AB recombinant likely represents the second most prevalent genetic form (5.2%) after subtype A6 and reaches a high prevalence (3.0%-12.0%) in Belarus, Russia, and Lithuania [ 26 , 34 , 37 ].…”