Niculescu Iulia, Paraschiv Simona, Paraskevis Dimitrios, Abagiu Adrian, Batan Ionelia, Banica Leontina, Otelea Dan
1 "Prof. Dr. Matei Bals" National Institute for Infectious Diseases, Bucharest , Romania .
AIDS Res Hum Retroviruses. 2015 May;31(5):488-95. doi: 10.1089/aid.2014.0189. Epub 2014 Nov 4.
Since 2011, Romania has faced an HIV outbreak among injecting drug users (IDUs). Our aim was to identify and describe clinical and epidemiological patterns of this outbreak. A cross-sectional study enrolled 138 IDUs diagnosed with HIV infection between 2011 and 2013 with 58 sexually infected individuals included as the control group. The IDUs had a long history of heroin abuse (10 years) and a recent history of new psychostimulant injection (3-4 years). Classical epidemiological data and molecular techniques were used to describe the transmission dynamics. A high prevalence of hepatitis C virus (HCV) coinfection was noted (98.6%) compared to the control group (10.3%) (p<0.001). IDUs had initially been infected with HCV. HIV infection was more recent, linked to starting injecting stimulants. HIV subtype analysis showed a predominance of the local F1 strain in both IDUs and sexually infected patients; in IDUs it also identified 28 CRF14_BG recombinants and six unique recombinant forms (URFs) between F1 and CRF14_BG. A few patients from both risk groups were infected with subtype B. Among IDUs, CRF14_BG was associated with a lower CD4 cell count and more advanced stages of disease, which correlated with CXCR4 tropism. Phylogenetic analysis revealed the spread of HIV through three major IDU clusters of recent date. Among IDUs with CRF14_BG, some reported travel abroad (Spain, Greece). By identifying clusters of IDUs with related viruses, molecular epidemiologic methods provide valuable information on patterns of HIV transmission that can be useful in planning appropriate harm reduction interventions.
自2011年以来，罗马尼亚注射吸毒者（IDU）中出现了HIV疫情。我们的目的是识别并描述此次疫情的临床和流行病学模式。一项横断面研究纳入了2011年至2013年间确诊感染HIV的138名注射吸毒者，另有58名性传播感染个体作为对照组。这些注射吸毒者有长期滥用海洛因的历史（10年），近期有注射新型精神兴奋剂的历史（3 - 4年）。采用经典流行病学数据和分子技术来描述传播动态。与对照组（10.3%）相比，丙型肝炎病毒（HCV）合并感染的患病率很高（98.6%）（p<0.001）。注射吸毒者最初感染的是HCV。HIV感染则是近期发生的，与开始注射兴奋剂有关。HIV亚型分析显示，在注射吸毒者和性传播感染患者中，本地F1毒株占主导；在注射吸毒者中还鉴定出28个CRF14_BG重组体以及F1和CRF14_BG之间的6种独特重组形式（URF）。两个风险组中的少数患者感染的是B亚型。在注射吸毒者中，CRF14_BG与较低的CD4细胞计数和更晚期的疾病阶段相关，这与CXCR4嗜性相关。系统发育分析揭示了HIV通过近期的三个主要注射吸毒者群体传播。在感染CRF14_BG的注射吸毒者中，一些人报告曾出国旅行（西班牙、希腊）。通过识别携带相关病毒的注射吸毒者群体，分子流行病学方法提供了有关HIV传播模式的宝贵信息，这有助于规划适当的减少伤害干预措施。
