Abstract
A molecular epidemiology study of HIV-1 infection was conducted in one hundred diagnosed and untreated HIV-1-infected patients in Cyprus between 2010 and 2012, representing 65.4% of all the reported HIV-1 infections in Cyprus in this three-year period, using a previously defined enrolment strategy. Eighty-two patients were newly diagnosed (genotypic drug resistance testing within six months from diagnosis), and eighteen patients were HIV-1 diagnosed for a longer period or the diagnosis date was unknown. Phylogenetic trees of the pol sequences obtained in this study with reference sequences indicated that subtypes B and A1 were the most common subtypes present and accounted for 41.0 and 19.0% respectively, followed by subtype C (7.0%), F1 (8.0%), CRF02_AG (4.0%), A2 (2.0%), other circulating recombinant forms (CRFs) (7.0%) and unknown recombinant forms (URFs) (12%). Most of the newly-diagnosed study subjects were Cypriots (63%), males (78%) with median age 39 (Interquartile Range, IQR 33–48) reporting having sex with other men (MSM) (51%). A high rate of clustered transmission of subtype B drug-sensitive strains to reverse transcriptase and protease inhibitors was observed among MSM, twenty-eight out of forty-one MSM study subjects (68.0%) infected were implicated in five transmission clusters, two of which are sub-subtype A1 and three of which are subtype B strains. The two largest MSM subtype B clusters included nine and eight Cypriot men, respectively, living in all major cities in Cyprus. There were only three newly diagnosed patients with transmitted drug resistant HIV-1 strains, one study subject from the United Kingdom infected with subtype B strain and one from Romania with sub-subtype A2 strain, both with PI drug resistance mutation M46L and one from Greece with sub-subtype A1 with non-nucleoside reverse transcriptase inhibitors (NNRTI) drug resistance mutation K103N.
Highlights
In the last twenty years, combined antiretroviral drug therapy, has been developed to target HIV-1 with outstanding success, resulting in a dramatic decrease in mortality among HIV-1-infected individuals
For the period 2010 to 2012 blood samples were obtained from one hundred consenting HIV1-infected individuals from the AIDS Clinic of Larnaca National Hospital, representing 65.4% of all the reported HIV-1 infections in Cyprus in this three-year period
Study subjects were retrospectively enrolled in this study after written consent followed by the submission of a questionnaire containing clinical, demographic and epidemiological information that was filled by qualified medical personnel at the AIDS Clinic of Larnaca National Hospital
Summary
In the last twenty years, combined antiretroviral drug therapy (cART), has been developed to target HIV-1 with outstanding success, resulting in a dramatic decrease in mortality among HIV-1-infected individuals. The main findings from the aforementioned HIV-1 molecular epidemiological studies in Cyprus is first, the high genetic heterogeneity of HIV-1 infection in the island as a result of a continuous influx of new HIV-1 strains from many countries, mainly from African countries, and second, the low transmitted resistance to HIV-1 antiretroviral drugs. As part of our ongoing effort to monitor the genetic diversity of HIV-1 infection and the transmission of antiretroviral drug resistant HIV-1 strains in Cyprus, in this molecular epidemiological study we generated and analyzed HIV-1 pol sequences from one hundred HIV-1 diagnosed and untreated patients in Cyprus between 2010 and 2012 (65.4% of reported HIV-1 infections in Cyprus in this three-year period), using a previously defined enrolment strategy and previously established experimental procedures [11,12,13]. We examined the reported risk factors and other epidemiological information in an effort to gain further understanding into risks underlying the observed HIV-1 transmission networks in Cyprus during the three-year period, between 2010 and 2012
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