title: Assessing the HIV-1 Epidemic in Brazilian Drug Users: A Molecular Epidemiology Approach.
abstract: Person who inject illicit substances have an important role in HIV-1 blood and sexual transmission and together with person who uses heavy non-injecting drugs may have less than optimal adherence to anti-retroviral treatment and eventually could transmit resistant HIV variants. Unfortunately, molecular biology data on such key population remain fragmentary in most low and middle-income countries. The aim of the present study was to assess HIV infection rates, evaluate HIV-1 genetic diversity, drug resistance, and to identify HIV transmission clusters in heavy drug users (DUs). For this purpose, DUs were recruited in the context of a Respondent-Driven Sampling (RDS) study in different Brazilian cities during 2009. Overall, 2,812 individuals were tested for HIV, and 168 (6%) of them were positive, of which 19 (11.3%) were classified as recent seroconverters, corresponding to an estimated incidence rate of 1.58%/year (95% CI 0.92-2.43%). Neighbor joining phylogenetic trees from env and pol regions and bootscan analyses were employed to subtype the virus from132 HIV-1-infected individuals. HIV-1 subtype B was prevalent in most of the cities under analysis, followed by BF recombinants (9%-35%). HIV-1 subtype C was the most prevalent in Curitiba (46%) and Itajaí (86%) and was also detected in Brasília (9%) and Campo Grande (20%). Pure HIV-1F infections were detected in Rio de Janeiro (9%), Recife (6%), Salvador (6%) and Brasília (9%). Clusters of HIV transmission were assessed by Maximum likelihood analyses and were cross-compared with the RDS network structure. Drug resistance mutations were verified in 12.2% of DUs. Our findings reinforce the importance of the permanent HIV-1 surveillance in distinct Brazilian cities due to viral resistance and increasing subtype heterogeneity all over Brazil, with relevant implications in terms of treatment monitoring, prophylaxis and vaccine development.
authors.affiliation: Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz- FIOCRUZ, Rio de Janeiro, Brasil.
authors.forename: Monick Lindenmeyer
authors.initials: ML
authors.lastname: Guimarães
authors.affiliation: Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz- FIOCRUZ, Rio de Janeiro, Brasil.
authors.forename: Bianca Cristina Leires
authors.initials: BC
authors.lastname: Marques
authors.affiliation: Instituto de Comunicação e Informação Científica e Tecnológica em Saúde- FIOCRUZ, Rio de Janeiro, Brasil.
authors.forename: Neilane
authors.initials: N
authors.lastname: Bertoni
authors.affiliation: Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz- FIOCRUZ, Rio de Janeiro, Brasil.
authors.forename: Sylvia Lopes Maia
authors.initials: SL
authors.lastname: Teixeira
authors.affiliation: Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz- FIOCRUZ, Rio de Janeiro, Brasil.
authors.forename: Mariza Gonçalves
authors.initials: MG
authors.lastname: Morgado
authors.affiliation: Instituto de Comunicação e Informação Científica e Tecnológica em Saúde- FIOCRUZ, Rio de Janeiro, Brasil.
authors.forename: Francisco Inácio
authors.initials: FI
authors.lastname: Bastos
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage; D001938:Brazil / Q000453:epidemiology; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics*; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D008297:Male; D015995:Prevalence; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D054299:env Gene Products, Human Immunodeficiency Virus / Q000235:genetics*; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics*
chemical_list: D044966:Anti-Retroviral Agents; D054299:env Gene Products, Human Immunodeficiency Virus; D054302:pol Gene Products, Human Immunodeficiency Virus