title: Expansion of the CRF19_cpx Variant in Spain.
abstract: BACKGROUND
  HIV-1 CRF19_cpx, is a recombinant variant found almost exclusively in Cuba and recently associated to a faster AIDS onset. Infection with this variant leads to higher viral loads and levels of RANTES and CXCR4 co-receptor use.
  
  
  OBJECTIVE
  The goal of this study was to assess the presence of CRF19_cpx in the Spanish province of Valencia, given its high pathogenicity.
  
  
  METHODS
  1294 HIV-1 protease-reverse transcriptase (PR/RT) sequences were obtained in Valencia (Spain), between 2005 and 2014. After subtyping, the detected CRF19_cpx sequences were aligned with 201 CRF19_cpx and 66 subtype D sequences retrieved from LANL, and subjected to maximum-likelihood phylogenetic analyses and Bayesian coalescent reconstructions. The presence of resistance mutations in the PR/RT region of these sequences was also analyzed.
  
  
  RESULTS
  Among the 9 CRF19_cpx sequences from different patients found (prevalence <0.1%), 7 grouped in two well-supported clades (groups A, n=4, and B, n=3), suggesting the existence of at least two independent introductions which subsequently started to expand in the studied Spanish region. Unprotected sex between men was the only known transmission route. Coalescent analyses suggested that the introductions in Valencia occurred between 2008 and 2010. Resistance mutations in the RT region were found in all sequences from group A (V139D) and in two sequences from group B (E138A).
  
  
  CONCLUSIONS
  This study reports for the first time the recent expansion of CRF19_cpx outside Cuba. Our results suggest that CRF19_cpx might become an emerging HIV variant in Spain, affecting Spanish native MSM and not only Cuban migrants.
authors.affiliation: Unidad Mixta Infección y Salud FISABIO-Universidad de Valencia/Instituto Cavanilles de Biodiversidad y Biología Evolutiva, Valencia, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Valencia, Spain.
authors.forename: Juan Angel
authors.initials: JA
authors.lastname: Patiño Galindo
authors.affiliation: Unidad Mixta Infección y Salud FISABIO-Universidad de Valencia/Instituto Cavanilles de Biodiversidad y Biología Evolutiva, Valencia, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Valencia, Spain.
authors.forename: Manoli
authors.initials: M
authors.lastname: Torres-Puente
authors.affiliation: Servicio de Microbiología, Hospital General Universitario, Valencia, Spain; Dpto. Microbiología, Universidad de Valencia, Valencia, Spain.
authors.forename: Concepción
authors.initials: C
authors.lastname: Gimeno
authors.affiliation: Unidad de Enfermedades Infecciosas, Hospital General Universitario, Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Ortega
authors.affiliation: Dpto. Microbiología, Universidad de Valencia, Valencia, Spain; Servicio de Microbiología, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Navarro
authors.affiliation: Unidad de Enfermedades Infecciosas, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Galindo
authors.affiliation: Servicio de Microbiología, Hospital de Manises, Manises, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Navarro
authors.affiliation: Servicio de Microbiología, Hospital de Manises, Manises, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Navarro
authors.affiliation: Centro de Información y Prevención del SIDA, Valencia, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Juan
authors.affiliation: Centro de Información y Prevención del SIDA, Alicante, Spain.
authors.forename: Josefina
authors.initials: J
authors.lastname: Belda
authors.affiliation: Unidad Mixta Infección y Salud FISABIO-Universidad de Valencia/Instituto Cavanilles de Biodiversidad y Biología Evolutiva, Valencia, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Valencia, Spain.
authors.forename: María Alma
authors.initials: MA
authors.lastname: Bracho
authors.affiliation: Unidad Mixta Infección y Salud FISABIO-Universidad de Valencia/Instituto Cavanilles de Biodiversidad y Biología Evolutiva, Valencia, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Valencia, Spain; Consorcio para la Investigación en VIH y SIDA de la Comunidad Valenciana, Spain. Electronic address: fernando.gonzalez@uv.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: González-Candelas
mesh_terms: D001499:Bayes Theorem; D015658:HIV Infections / Q000453:epidemiology / Q000821:virology*; D016333:HIV Protease / Q000235:genetics; D054303:HIV Reverse Transcriptase / Q000235:genetics; D015497:HIV-1 / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D016013:Likelihood Functions; D009154:Mutation; D010802:Phylogeny; D058974:Phylogeography; D012367:RNA, Viral / Q000032:analysis; D013030:Spain / Q000453:epidemiology
chemical_list: D012367:RNA, Viral; C514824:reverse transcriptase, Human immunodeficiency virus 1; D054303:HIV Reverse Transcriptase; D016333:HIV Protease
keywords: CRF19_cpx; HIV-1; Molecular epidemiology