The HIV type 1 epidemic in Bulgaria involves multiple subtypes and is sustained by continuous viral inflow from West and East European countries.
Little is known about the HIV-1 epidemic in Balkan countries. To fill the gap, we investigated the viral genetic diversity in Bulgaria, by sequencing and phylogenetic characterization of 86 plasma samples collected between 2002 and 2006 from seropositive individuals diagnosed within 1986-2006. Analysis of pol gene sequences assigned 51% of the samples to HIV-1 subtype B and 27% to subtype A1. HIV-1 subtype C, F, G, H, and a few putative recombinant forms were also found. Phylogenetic and molecular clock analysis showed a continuous exchange of subtype A and B between Bulgaria and Western as well as other Eastern European countries. At least three separate introductions of HIV-1 subtype A and four of HIV-1 subtype B have occurred within the past 25 years in Bulgaria. The central geographic location of Bulgaria, the substantial genetic heterogeneity of the epidemic with multiple subtypes, and the significant viral flow observed to and from the Balkan countries have the potential to modify the current HIV-1 epidemiological structure in Europe and highlight the importance of more extensive and continuous monitoring of the epidemic in the Balkans.
Salemi
Marco
M
Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida 32610, USA.
Goodenow
Maureen M
MM
Montieri
Stefania
S
de Oliveira
Tulio
T
Santoro
Maria Mercedes
MM
Beshkov
Danail
D
Alexiev
Ivailo
I
Elenkov
Ivailo
I
Elenkov
Ivan
I
Yakimova
Tsvetana
T
Varleva
Tonka
T
Rezza
Giovanni
G
Ciccozzi
Massimo
M
D000328:Adult; D001483:Base Sequence; D001499:Bayes Theorem; D002031:Bulgaria / Q000453:epidemiology; D015331:Cohort Studies; D004196:Disease Outbreaks; D004641:Emigration and Immigration; D005260:Female; D051456:Gene Flow; D014644:Genetic Variation; D015658:HIV Infections / Q000453:epidemiology / Q000235:genetics; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D017720:Molecular Epidemiology; D008969:Molecular Sequence Data; D009010:Monte Carlo Method; D010802:Phylogeny; D012367:RNA, Viral / Q000097:blood; D016415:Sequence Alignment; D017423:Sequence Analysis, RNA; D013997:Time Factors; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics*
D012367:RNA, Viral; D054302:pol Gene Products, Human Immunodeficiency Virus