Abstract
BackgroundCRF19_cpx is a complex circulating recombination form (CRF) of HIV-1. We describe the characteristics of an outbreak of the CRF19_cpx variant among treatment-naïve patients in southern Spain.MethodsThe study was undertaken at the Virgen de la Victoria Hospital, a reference centre for the analysis of HIV-1 genotype in Malaga (Spain). Subtyping was performed through REGA v3.0 and the relationship of our CRF19_cpx sequences, among themselves and regarding other reference sequences from the same variant, was defined by phylogenetic analysis. We used PhyML program to perform a reconstruction of the phylogeny by Maximum Likelihood method as well as further confirmation of the transmission clusters by Bayesian inference. Additionally, we collected demographic, clinical and immunovirological data.ResultsBetween 2011 and 2016, we detected 57 treatment-naïve patients with the CRF19_cpx variant. Of these, 55 conformed a very well-defined transmission cluster, phylogenetically close to CRF19_cpx sequences from the United Kingdom. The origin of this subtype in Malaga was dated between 2007 and 2010. Over 50% of the patients presented the non-nucleoside reverse transcriptase inhibitor G190A resistance mutation. This variant was mostly represented by young adult Spanish men who had sex with men. Almost half of them were recent seroconverters, though a similar percentage was diagnosed at a late state of HIV infection. Five cases of AIDS and one non-AIDS defined death occurred during follow-up. The majority of patients treated with first-line combination antiretroviral therapy (ART) responded.ConclusionsWe report the largest HIV-1 CRF19_cpx cohort of treatment-naïve patients outside Cuba, almost all emerging as an outbreak in the South of Spain. Half the cases had the G190A resistance mutation. Unlike previous studies, the variant from Malaga seems less pathogenic, with few AIDS events and an excellent response to ART.
Highlights
CRF19_cpx is a complex circulating recombination form (CRF) of HIV-1, exhibiting a mosaic structure with multiple segments of subtypes A, D, and G
Over 50% of the patients presented the non-nucleoside reverse transcriptase inhibitor G190A resistance mutation. This variant was mostly represented by young adult Spanish men who had sex with men
Almost half of them were recent seroconverters, though a similar percentage was diagnosed at a late state of HIV infection
Summary
CRF19_cpx is a complex circulating recombination form (CRF) of HIV-1, exhibiting a mosaic structure with multiple segments of subtypes A, D, and G. Molecular epidemiology studies suggest a central African origin for this variant [1,2], CRF19_cpx was first described in HIV-1 patients from Cuba [1], where it was imported around the mid-1980s and rapidly disseminated within local transmission networks [2]. This recombinant form represents almost 4% of all subtypes and more than 17% of all the CRFs in newly diagnosed Cuban patients [3,4,5]. We describe the characteristics of an outbreak of the CRF19_cpx variant among treatment-naïve patients in southern Spain
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