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HIV-1 subtype distribution and its demographic determinants in newly diagnosed patients in Europe suggest highly compartmentalized epidemics

Ana B Abecasis12*, Annemarie MJ Wensing3, Dimitris Paraskevis4, Jurgen Vercauteren56, Kristof Theys5, David AMC Van de Vijver7, Jan Albert89, Birgitta Asjö10, Claudia Balotta11, Danail Beshkov12, Ricardo J Camacho132, Bonaventura Clotet14, Cillian De Gascun15, Algis Griskevicius16, Zehava Grossman17, Osamah Hamouda18, Andrzej Horban19, Tatjana Kolupajeva20, Klaus Korn21, Leon G Kostrikis22, Claudia Kücherer18, Kirsi Liitsola23, Marek Linka24, Claus Nielsen25, Dan Otelea26, Roger Paredes14, Mario Poljak27, Elisabeth Puchhammer-Stöckl28, Jean-Claude Schmit2930, Anders Sönnerborg31, Danika Stanekova32, Maja Stanojevic33, Daniel Struck29, Charles AB Boucher7 and Anne-Mieke Vandamme25

Author Affiliations

1 Unidade de Saúde Pública Internacional e Bioestatística, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal

2 Centro de Malária e Outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal

3 Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands

4 Department of Hygiene Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece

5 Rega Institute for Medical Research, KU Leuven, Leuven, Belgium

6 StatUa Center for Statistics, Universiteit Antwerpen, Antwerpen, Belgium

7 Department of Virology, Erasmus Medical Center, Rotterdam, the Netherlands

8 Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden

9 Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden

10 Section for Microbiology and Immunology, The Gade Institute, University of Bergen, Bergen, Norway

11 University of Milan, Milan, Italy

12 Department of Virology, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria

13 Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal

14 irsiCaixa AIDS Research Institute & Lluita contra la SIDA Foundation, Hospital Universitari "Germans Tria si Pujol", Badalona, Spain

15 University College Dublin, Dublin, Ireland

16 National Public Health Surveillance Laboratory, Vilnius, Lithuania

17 Sheba Medical Center, Ramat Gan, and Tel Aviv University, Tel Aviv, Israel

18 Robert-Koch Institute, Berlin, Germany

19 Warsaw Medical University and Hospital of Infectious Diseases, Warsaw, Poland

20 Infectology Center of Latvia, Riga, Latvia

21 Institut für Klinische und Molekulare Virologie, University of Erlangen-Nuremberg, Erlangen, Germany

22 University of Cyprus, Nicosia, Cyprus

23 National Institute for Health and Welfare, Helsinki, Finland

24 National Institute of Public Health, Prague, Czech Republic

25 Statens Serum Institute, Copenhagen, Denmark

26 Molecular Diagnostics, "Prof. Dr .Matei Bals" Institute for Infectious Diseases, Bucharest, Romania

27 University of Ljubljana, Ljubljana, Slovenia

28 Medical University Vienna, Vienna, Austria

29 Laboratory of Retrovirology, CRP-Santé, Luxembourg, Luxembourg

30 Centre Hospitalier de Luxembourg, Rollengergronn-Belair-Nord, Luxembourg

31 Divisions of Infectious Diseases and Clinical Virology, Karolinska Institute, Stockholm, Sweden

32 Slovak Medical University, Bratislava, Slovakia

33 University of Belgrade, School of Medicine, Belgrade, Serbia

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Retrovirology 2013, 10:7  doi:10.1186/1742-4690-10-7

Published: 14 January 2013

Abstract

Background

Understanding HIV-1 subtype distribution and epidemiology can assist preventive measures and clinical decisions. Sequence variation may affect antiviral drug resistance development, disease progression, evolutionary rates and transmission routes.

Results

We investigated the subtype distribution of HIV-1 in Europe and Israel in a representative sample of patients diagnosed between 2002 and 2005 and related it to the demographic data available. 2793 PRO-RT sequences were subtyped either with the REGA Subtyping tool or by a manual procedure that included phylogenetic tree and recombination analysis. The most prevalent subtypes/CRFs in our dataset were subtype B (66.1%), followed by sub-subtype A1 (6.9%), subtype C (6.8%) and CRF02_AG (4.7%). Substantial differences in the proportion of new diagnoses with distinct subtypes were found between European countries: the lowest proportion of subtype B was found in Israel (27.9%) and Portugal (39.2%), while the highest was observed in Poland (96.2%) and Slovenia (93.6%). Other subtypes were significantly more diagnosed in immigrant populations. Subtype B was significantly more diagnosed in men than in women and in MSM > IDUs > heterosexuals. Furthermore, the subtype distribution according to continent of origin of the patients suggests they acquired their infection there or in Europe from compatriots.

Conclusions

The association of subtype with demographic parameters suggests highly compartmentalized epidemics, determined by social and behavioural characteristics of the patients.