Epidemic dispersion of HIV and HCV in a population of co-infected Romanian injecting drug users.

Simona Paraschiv,Ionelia Nicolae,Dan Otelea,Marta Pingarilho,Iulia Niculescu,Kristof Theys,Raluca Jipa,Adrian Abagiu,Pieter Libin,Ana Abecasis,Andrea-Clemencia Pineda-Peña,Emil Neaga,Leontina Banica

doi:10.1371/journal.pone.0185866

Abstract

Co-infections with HIV and HCV are very frequent among people who inject drugs (PWID). However, very few studies comparatively reconstructed the transmission patterns of both viruses in the same population. We have recruited 117 co-infected PWID during a recent HIV outbreak in Romania. Phylogenetic analyses were performed on HIV and HCV sequences in order to characterize and compare transmission dynamics of the two viruses. Three large HIV clusters (2 subtype F1 and one CRF14_BG) and thirteen smaller HCV transmission networks (genotypes 1a, 1b, 3a, 4a and 4d) were identified. Eighty (65%) patients were both in HIV and HCV transmission chains and 70 of those shared the same HIV and HCV cluster with at least one other patient. Molecular clock analysis indicated that all identified HIV clusters originated around 2006, while the origin of the different HCV clusters ranged between 1980 (genotype 1b) and 2011 (genotypes 3a and 4d). HCV infection preceded HIV infection in 80.3% of cases. Coincidental transmission of HIV and HCV was estimated to be rather low (19.65%) and associated with an outbreak among PWID during detention in the same penitentiary. This study has reconstructed and compared the dispersion of these two viruses in a PWID population.

Highlights

The use of contaminated needles is an effective way of spreading HIV; it accounts for 10% of infections worldwide and for more than 40% in some regions and countries (Eastern Europe, South America, and East and Southeast Asia) [1, 2]
HIV-1 subtype analysis showed that 67.5% (n = 79) of the patients were infected with subtype F1 viruses; recombinant forms present in a significant proportion (26%; n = 30) were CRF14_BG (n = 19, 16.24%) and unique recombinant forms (URF) of CRF_14BG and F1 (n = 11, 9.4%)
The people who inject drugs (PWID) represent no more than an estimated 0.2–0.5% of the world’s population, but they account for approximately 5–10% of all people living with HIV and 6.8% of the persons infected with HCV [36, 37]

Summary

Introduction

The use of contaminated needles is an effective way of spreading HIV; it accounts for 10% of infections worldwide and for more than 40% in some regions and countries (Eastern Europe, South America, and East and Southeast Asia) [1, 2]. HIV and HCV transmission patterns in Romanian PWID. HCV nucleotide sequences used in this analysis were recently deposited in Genbank. HCVNS5b sequences were deposited with the following accession numbers: KX158877 – KX158993. Accession numbers for HCV – NS3 nucleotide sequences corresponding to PWID are: KX159080 – KX159189 and for the monoinfected patients (control group) are: KX159190 – KX159224

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Conclusion