High HIV-1 diversity in immigrants resident in Italy (2008\u20132017)

Maria Teresa Maggiorella,Carmen Rita Santoro,Stefano Buttò,Gabriella D’Ettorre,Stefania D’Amato,Domenico Fulgenzi,Ivan Schietroma,Laura Monno,Alessandra Cenci,Barbara Ridolfi,Orietta Picconi,Silvia Angeletti,Fábio Zoboli ,Francesca Vichi,Claudia Rovetto,Francesco Cesario,Ruggero Losappio,Roberto Belli,G Berardelli ,Laura Mazzuti,Lorenzo Surace,Eleonora Cella,Issa El‐Hamad ,Leonardo Sernicola,Gaetano Brindicci,Massimo Ciccozzi,Elisa Mariabelli,Nunzia Sanarico,Annalisa Azzurri,Alessândra Borsetti ,Filippo Luciani,Patrizia Di Zeo,Nunzia Cuomo,Ombretta Turriziani,Nicola Coppola,Barbara Ensoli,Emanuela Salvi,Alice Poggi

doi:10.1038/s41598-020-59084-2

Abstract

The proportion of new diagnoses of HIV infection in immigrants residing in Italy raised from 11% in 1992 to 29.7% in 2018. To investigate the HIV clades circulating in this community a retrospective study was performed in 557 HIV-infected immigrants living in 12 Italian cities. Immigrants originated from East-Europe and Central-Asia (11.7%), North Africa and Middle East (7.3%), South and South-East Asia (7.2%), Latin America and the Caribbean (14.4%), and sub-Saharan Africa (59.4%). More than 87% of immigrants were on antiretroviral therapy (ART), although 26.6% of them were viremic. A 22.0% of immigrants had hepatitis (HBV and/or HCV) and/or tuberculosis. HIV phylogenetic analysis on sequences from 192 immigrants showed the presence of clades B (23.4%), G (16.1%), C (10.4%), A1 (9.4%), F1 (5.2%), D (1.6%) and Circulating Recombinant Forms (CRFs) (33.9%). CRF02_AG represented 72.3% of the total CRFs. Clusters between immigrants and Italian natives were also present. Drug resistance mutations to NRTI, NNRTI, and PI drug classes occurred in 29.1% of ART-treated and in 12.9% of ART-naïve individuals. These data highlight the need for tailored public health interventions in immigrants to avoid spreading in Italy of HIV genetic forms and ART-resistant variants, as well as HIV co-morbidities.

Highlights

The proportion of new diagnoses of HIV infection in immigrants residing in Italy raised from 11% in 1992 to 29.7% in 2018
Our study investigated the distribution of HIV subtypes and Circulating Recombinant Forms (CRFs) and the presence of their variants carrying mutations of resistance to antiretroviral therapy (ART) in the population of immigrants resident in Italy
Individuals were native of East Europe and Central Asia (EE & CA, 11.7%), Latin America and the Caribbean (LA & Car, 14.4%), North Africa and Middle East (NA & ME, 7.4%), South and South-East Asia (S & SEA, 7.2%) and Sub-Saharan Africa (SSA, 59.4%)

Summary

Introduction

The proportion of new diagnoses of HIV infection in immigrants residing in Italy raised from 11% in 1992 to 29.7% in 2018. HIV-1 genetic heterogeneity leads to the establishment of an increasing number of subtypes, sub-subtypes and Circulating Recombinant Forms (CRFs), which have a specific geographic distribution that, is continuously evolving because of travelling and migration[8]. These genetic forms can be transmitted with different efficiency[9,10] and have different sensitivity to ART11. Our study investigated the distribution of HIV subtypes and CRFs and the presence of their variants carrying mutations of resistance to antiretroviral therapy (ART) in the population of immigrants resident in Italy. In order to provide more information for health police in these communities, we described the clinical, virological and immunological characteristics of this population, as well as the presence of HBV and HCV co-infections and TB

Methods

Results

Conclusion