Clinical, virological and phylogenetic characterization of a multiresistant HIV-1 strain outbreak in naive patients in southern Spain.
BACKGROUND
We describe the characteristics of an HIV-1 strain with six viral reverse transcriptase mutations (D67N, T69N/D, V118I, V179D, T215S and K219Q), which we have called the Malaga strain. This strain was detected in treatment-naive patients from southern Spain.


METHODS
The study was undertaken at the Virgen de la Victoria Hospital, Malaga, a reference centre for the study of HIV-1 genotype resistance in Andalusia (the 'Costa del Sol'), Spain. Genotypic resistance testing was done in an automated sequencer. Phylogenetic analysis was performed using a 630 bp region of the reverse transcriptase with the mutations mentioned.


RESULTS
Between 2007 and 2014, we detected the Malaga strain in 30 treatment-naive patients. All were MSM, seen at five hospitals on the Costa del Sol. In all cases, the HIV-1 was subtype B with viral tropism R5. Phylogenetic analysis based on the reverse transcriptase sequence showed consistent grouping (with a bootstrap value of the common node of 100%) of the isolates that shared the mutation pattern mentioned. This strain has not been detected elsewhere or in previously treated patients. All of the patients treated with first-line combination ART responded.


CONCLUSIONS
We report a cluster of an HIV-1 strain with multiple resistance mutations that was transmitted over a period of >8 years, affecting 30 naive patients from the same geographical area. The strain was susceptible to first-line combination ART.
UGCI de Enfermedades Infecciosas y Microbiología Clínica, Hospital Virgen de la Victoria, Málaga, Spain Instituto de Investigación de Biomedicina de Málaga (IBIMA), Malaga, Spain.
I
I
Viciana
Instituto de Investigación de Biomedicina de Málaga (IBIMA), Malaga, Spain.
C M
CM
González-Domenech
UGCI de Enfermedades Infecciosas y Microbiología Clínica, Hospital Virgen de la Victoria, Málaga, Spain Instituto de Investigación de Biomedicina de Málaga (IBIMA), Malaga, Spain rosariopalaci@gmail.com.
R
R
Palacios
UGCI de Enfermedades Infecciosas y Microbiología Clínica, Hospital Regional Carlos Haya, Málaga, Spain.
M
M
Delgado
UGC de Enfermedades Infecciosas, Hospital Costa del Sol, Marbella, Spain.
A
A
Del Arco
UGC de Enfermedades Infecciosas y Microbiología Clínica, Hospital La Línea, AGS Campo de Gibraltar, Cádiz, Spain.
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F
Tellez
Servicio de Medicina Interna, Hospital Comarcal de Antequera, Malaga, Spain.
F
F
Jarilla
Servicio de Medicina Interna, Hospital Comarcal de la Axarquía, Vélez-Málaga, Spain.
S
S
Fernández
UGCI de Enfermedades Infecciosas y Microbiología Clínica, Hospital Virgen de la Victoria, Málaga, Spain.
E
E
Clavijo
UGCI de Enfermedades Infecciosas y Microbiología Clínica, Hospital Virgen de la Victoria, Málaga, Spain Instituto de Investigación de Biomedicina de Málaga (IBIMA), Malaga, Spain.
J
J
Santos
D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000494:pharmacology*; D016000:Cluster Analysis; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious; D024921:Drug Resistance, Multiple, Viral; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission / Q000821:virology*; D054303:HIV Reverse Transcriptase / Q000235:genetics; D015497:HIV-1 / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D020125:Mutation, Missense; D010802:Phylogeny; D017422:Sequence Analysis, DNA; D017385:Sequence Homology; D013030:Spain / Q000453:epidemiology
D044966:Anti-Retroviral Agents; C514824:reverse transcriptase, Human immunodeficiency virus 1; D054303:HIV Reverse Transcriptase