Low HIV-1 transmitted drug resistance in Bulgaria against a background of high clade diversity. (3rd February 2015)

• Record Type: Journal Article
• Authors: Alexiev, Ivailo; Shankar, Anupama; Wensing, A. M. J.; Beshkov, Danail; Elenkov, Ivaylo; Stoycheva, Mariyana; Nikolova, Daniela; Nikolova, Maria; Switzer, William M.
• Is Part Of: Journal of antimicrobial chemotherapy. Volume 70:Number 6(2015:Jun.)
• Page Start: 1874
• Page End: 1880
• Publication Date: 2015-02-03
• Subjects: antiretroviral mutations -- surveillance -- viral heterogeneity -- eastern Europe; Anti-infective agents -- Periodicals; Chemotherapy -- Periodicals; 615.58
• DOI: 10.1093/jac/dkv011
• Languages: English
• ISSNs: 0305-7453

Abstract

Abstract: Objectives: To determine transmitted drug resistance (TDR) and HIV-1 genetic diversity in Bulgaria. Methods: The prevalence of TDR and HIV-1 subtypes was determined in 305/1446 (21.1%) persons newly diagnosed with HIV/AIDS from 1988 to 2011. TDR mutations (TDRMs) in protease and reverse transcriptase were defined using the WHO HIV drug mutation list. Phylogenetic analysis was used to infer polymerase ( pol ) genotype. Results: TDRMs were found in 16/305 (5.2%) persons, 11 (3.6%) with resistance to NRTIs, 5 (1.6%) with resistance to NNRTIs and 3 (0.9%) with resistance to PIs. Dual-class TDRMs were found in three (1.0%) patients and one statistically supported cluster of TDRMs comprising two individuals with subtype B infection. TDRMs were found in 10 heterosexuals, 4 MSM and two intravenous drug users. Phylogenetic analyses identified high HIV-1 diversity consisting of mostly subtype B (44.6%), subtype C (3.3%), sub-subtype A1 (2.6%), sub-subtype F1 (2.3%), sub-subtype A-like (3.6%), subtype G (0.3%), CRF14_BG (1.6%), CRF05_DF (1.3%), CRF03_AB (0.3%) and unique recombinant forms (1.3%). Conclusions: We found a low prevalence of TDR against a background of high HIV-1 genetic diversity among antiretroviral-naive patients in Bulgaria. Our results provide baseline data on TDR and support continued surveillance of high-risk populations in Bulgaria to better target treatment and prevention efforts.