title: Recent HIV-1 Outbreak Among Intravenous Drug Users in Romania: Evidence for Cocirculation of CRF14_BG and Subtype F1 Strains.
abstract: Since 2011, Romania has faced an HIV outbreak among injecting drug users (IDUs). Our aim was to identify and describe clinical and epidemiological patterns of this outbreak. A cross-sectional study enrolled 138 IDUs diagnosed with HIV infection between 2011 and 2013 with 58 sexually infected individuals included as the control group. The IDUs had a long history of heroin abuse (10 years) and a recent history of new psychostimulant injection (3-4 years). Classical epidemiological data and molecular techniques were used to describe the transmission dynamics. A high prevalence of hepatitis C virus (HCV) coinfection was noted (98.6%) compared to the control group (10.3%) (p<0.001). IDUs had initially been infected with HCV. HIV infection was more recent, linked to starting injecting stimulants. HIV subtype analysis showed a predominance of the local F1 strain in both IDUs and sexually infected patients; in IDUs it also identified 28 CRF14_BG recombinants and six unique recombinant forms (URFs) between F1 and CRF14_BG. A few patients from both risk groups were infected with subtype B. Among IDUs, CRF14_BG was associated with a lower CD4 cell count and more advanced stages of disease, which correlated with CXCR4 tropism. Phylogenetic analysis revealed the spread of HIV through three major IDU clusters of recent date. Among IDUs with CRF14_BG, some reported travel abroad (Spain, Greece). By identifying clusters of IDUs with related viruses, molecular epidemiologic methods provide valuable information on patterns of HIV transmission that can be useful in planning appropriate harm reduction interventions.
authors.affiliation: 1 "Prof. Dr. Matei Bals" National Institute for Infectious Diseases, Bucharest , Romania .
authors.forename: Iulia
authors.initials: I
authors.lastname: Niculescu
authors.forename: Simona
authors.initials: S
authors.lastname: Paraschiv
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Paraskevis
authors.forename: Adrian
authors.initials: A
authors.lastname: Abagiu
authors.forename: Ionelia
authors.initials: I
authors.lastname: Batan
authors.forename: Leontina
authors.initials: L
authors.lastname: Banica
authors.forename: Dan
authors.initials: D
authors.lastname: Otelea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D055030:Drug Users; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D015497:HIV-1 / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D008969:Molecular Sequence Data; D010802:Phylogeny; D015995:Prevalence; D012383:Romania / Q000453:epidemiology; D017422:Sequence Analysis, DNA; D015819:Substance Abuse, Intravenous / Q000150:complications*; D055815:Young Adult