United States Military HIV Research Program, Silver Spring, MD, United States of America.
The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America.
PLoS One. 2019 May 28;14(5):e0217063. doi: 10.1371/journal.pone.0217063. eCollection 2019.
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.
HIV-1 病毒在保加利亚的株系多样性非常广泛，包括几乎所有主要亚型和循环重组形式（CRF）的贡献：01_AE、02_AG 和 05_DF。在此研究之前，保加利亚的 HIV-1 序列信息仅基于前逆转录酶基因，这只代表病毒基因组的不到 15%。为了进一步描述保加利亚的 HIV-1 情况，评估参与者的风险行为，并加强对该地区流行株系的了解，进行了名为“保加利亚 HIV-1 的遗传亚型（RV240）”的研究。本研究采用基于实时 PCR 的多区域杂交分析（MHA）B/非-B 和 HIV-1 测序，调查了大约 1100 名已知感染 HIV-1 的保加利亚成年人中的 215 名（2008-2009 年），并确定他们是否感染了 B 型 HIV-1。结果表明 B 型流行率为 40%，并证明了 MHA B/非-B 在包含广泛 HIV-1 株系多样性的地区的应用。在所评估的风险行为中，B 型感染的比例在男男性行为者中最高，在有吸毒风险因素的人群中最低。在这项研究中，从研究参与者中分离出 15 个近乎全长的基因组和 22 个包膜序列。系统发育分析显示存在 A1、B、C、F1 和 G 亚型、CRF01_AE、CRF02_AG、CRF05_DF 和一种独特的重组形式（URF）。这些序列还显示出存在两组包含具有相似风险因素的参与者的菌株。先前在非洲和亚洲队列中的研究表明，多种亚型的共同循环可能导致超级感染个体中的病毒重组和新 URF 的出现。在本研究中，高亚型多样性的情况下 URF 低流行率可能是成功的感染预防和控制计划的结果。继续进行流行病学监测和支持感染预防计划将有助于维持保加利亚的 HIV-1 流行控制。
