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. 2019 May 28;14(5):e0217063.
doi: 10.1371/journal.pone.0217063. eCollection 2019.

HIV-1 genetic diversity and demographic characteristics in Bulgaria

Erik Billings  1   2 , Richard A Heipertz  1   3 , Tonka Varleva  4 , Eric Sanders-Buell  1   2 , Anne Marie O'Sullivan  1   2 , Meera Bose  1   2 , Shana Howell  1   2 , Gustavo H Kijak  1   2 , Hristo Taskov  5 , Ivailo Elenkov  6 , Marina Nenova  7 , Nedialka Popivanova  8 , Aimee Bolen Valenzuela  1   2 , Otha Myles  1   3 , Christian T Bautista  2   3 , Merlin L Robb  1   2 , Nelson L Michael  1   3 , Jerome H Kim  1 , Paul T Scott  1   3 , Sodsai Tovanabutra  1   2 , Julie A Ake  1   3
Affiliations

HIV-1 genetic diversity and demographic characteristics in Bulgaria

Erik Billings et al. PLoS One. .

Abstract

HIV-1 strain diversity in Bulgaria is extensive and includes contributions from nearly all major subtypes and the Circulating Recombinant Forms (CRF): 01_AE, 02_AG, and 05_DF. Prior to this study, HIV-1 sequence information from Bulgaria has been based solely on the pro-RT gene, which represent less than 15% of the viral genome. To further characterize HIV-1 in Bulgaria, assess participant risk behaviors, and strengthen knowledge of circulating strains in the region, the study "Genetic Subtypes of HIV-1 in Bulgaria (RV240)" was conducted. This study employed the real time-PCR based Multi-region Hybridization Assay (MHA) B/non-B and HIV-1 sequencing to survey 215 of the approximately 1100 known HIV-1 infected Bulgarian adults (2008-2009) and determine if they were infected with subtype B HIV-1. The results indicated a subtype B prevalence of 40% and demonstrate the application of the MHA B/non-B in an area containing broad HIV-1 strain diversity. Within the assessed risk behaviors, the proportion of subtype B infection was greatest in men who have sex with men and lowest among those with drug use risk factors. During this study, 15 near full-length genomes and 22 envelope sequences were isolated from study participants. Phylogenetic analysis shows the presence of subtypes A1, B, C, F1, and G, CRF01_AE, CRF02_AG, CRF05_DF, and one unique recombinant form (URF). These sequences also show the presence of two strain groups containing participants with similar risk factors. Previous studies in African and Asian cohorts have shown that co-circulation of multiple subtypes can lead to viral recombination within super-infected individuals and the emergence of new URFs. The low prevalence of URFs in the presence of high subtype diversity in this study, may be the result of successful infection prevention and control programs. Continued epidemiological monitoring and support of infection prevention programs will help maintain control of the HIV-1 epidemic in Bulgaria.

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Conflict of interest statement

GHK is currently a paid employee of GlaxoSmithKline. However, his contribution to the research reported on in this paper took place prior to this commercial affiliation. This does not affect our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development, or marketed products to declare.The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Army, DoD, or US government.

Figures

Fig 1
Fig 1. MHA B/Non-B probe locations.
HXB2 referenced positions of the six probe locations in the HIV-1 genome.
Fig 2
Fig 2. HIV-1 subtype distribution across three study sites in Bulgaria.
Proportion of subtype B and non-B infections at each of the three study sites.
Fig 3
Fig 3. Phylogenetic tree of HIV-1 env sequences from Bulgaria.
Neighbor-joining tree of env gene sequences denoted with group subtypes, participant age at enrollment, gender, and self-identified risk factors. Study participant strains from pure subtypes are shown in blue and recombinant strains are shown in red. The trio of males with intra-group genetic distances less than 3% are marked with *. Bootstrap values at relevant nodes are shown. The scale bar indicates a genetic distance of 10%.
Fig 4
Fig 4. Phylogenetic tree of full-length HIV-1 sequences from Bulgaria.
Neighbor-joining tree of full-length sequences denoted with group subtypes, participant age at enrollment, gender, and self-identified risk factors. Study participant strains from pure subtypes are shown in blue and recombinant strains are shown in red. The closely related pair of strains with an env genetic distance of 2.5% are marked with *. Bootstrap values at relevant nodes are shown. The scale bar indicates a genetic distance of 10%.
See this image and copyright information in PMC

References

    1. Ivanov IA, Beshkov D, Shankar A, Hanson DL, Paraskevis D, Georgieva V, et al. Detailed molecular epidemiologic characterization of HIV-1 infection in Bulgaria reveals broad diversity and evolving phylodynamics. PloS One. 2013;8(3):e59666 10.1371/journal.pone.0059666 - DOI - PMC - PubMed
    1. Alexiev I, Shankar A, Dimitrova R, Gancheva A, Kostadinova A, Teoharov P, et al. Origin and spread of HIV-1 in persons who inject drugs in Bulgaria. Infection, Genetics and Evolution: Journal of Molecular Epidemiology and Evolutionary Genetics in Infectious Diseases. 2016;46:269–78. 10.1016/j.meegid.2016.05.029 - DOI - PMC - PubMed
    1. European Centre for Disease Prevention and Control, WHO Regional Office for Europe. HIV/AIDS Surveillance in Europe 2014. Stockholm: ECDC; 2015. Available from: https://ecdc.europa.eu/en/publications-data Cited 10 May 2019.
    1. European Centre for Disease Prevention and Control, WHO Regional Office for Europe. HIV/AIDS Surveillance in Europe 2013. Stockholm: ECDC; 2014. Available from: https://ecdc.europa.eu/en/publications-data Cited 10 May 2019.
    1. Joint United Nations Programme on HIV/AIDS (UNAIDS). Global report: UNAIDS Report on the Global AIDS Epidemic 2013. Available from: http://www.unaids.org/en/resources/documents/2013/20130923_UNAIDS_Global... Cited 10 May 2019.

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