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Presentación de PowerPoint - Programme-at-a
TUPEA060 New HIV-1 diagnoses in Spain frequently group in clusters of subtype B and non-subtype B genetic forms Elena Delgado*, Jesús Martínez, Mª Teresa Cuevas, Aurora Fernández-García, Yolanda Vega, Vanessa Montero, Cristina Carrera, Mónica Sánchez, Elena García-Bodas, Lucía Pérez-Álvarez, Michael M. Thomson* and The Spanish Group for the Study of HIV-1 Antiretroviral Drug Resistance and Tropism†. Unidad de Biología y Variabilidad del VIH, Centro Nacional de Microbiología, Instituto de Salud Carlos III. Majadahonda, Madrid, Spain. *e-mail: [email protected]; [email protected] Background: B08 A recent increase in phylogenetic clustering among new HIV-1 infections has been observed in many countries, frequently associated with men who have sex with men (MSM). Here we analyze phylogenetic clustering among newly diagnosed HIV-1 infections of 6 regions of Spain. B10 B49 B75 B36 B43 B14 B01 B05 B.RF B26 B29 B11 B54 B35 B.SF2 B.HXB2 B.JRFL B32 B06 B156 Methods: Samples were collected from HIV-1-infected individuals newly diagnosed in 2013 and 2014, attended in 19 hospitals from 6 Spanish regions (Galicia, Basque Country, Navarre, Castilla y León, Madrid, and Extremadura). RNA extracted from plasma was used for RT-PCR amplification and sequencing of protease and reverse transcriptase (PR-RT), env V3 region, or both. Phylogenetic analyses were performed via maximum likelihood with RAxML and PhyML, applying the GTR+G+I evolutionary model. Clusters were defined as those supported by bootstrap values ≥90% with RAxML and by aLRT SH-like values ≥0.9 with PhyML, and comprising ≥4 individuals with a majority being native Spanish. In these analyses, sequences from samples collected in previous years in Spain and sequenced by us were also included. Results: CRF06_cpx CRF02_AG CRF19_cpx CRF27_cpx CRF29_BF CRF01_AE G B04 B12 B31 22 8 6 CRF47_BF B70 Non B 142 (31%) B 314 27 6 B 28 B07 31 F1 B50 2 N= 456 D 14 C URFs 14 B09 B28 A1 B13 Figure 1. Distribution of HIV-1 genetic forms of samples from 456 individuals newly diagnosed of HIV-1 infection in 2013 and 2014. Samples were sequenced, either both in PR-RT and V3 (n=272), only in PR-RT (n=154), or only in V3 (n=30). 142 (31%) non-subtype B infections were identified. Number of clusters A) 39 40 30 26 non MSM 17 20 10 10 0 MSM CRF47_BF D.ELI D.84ZE085 Figure 2. Geographic distribution of new HIV-1 diagnoses (ND) of this study. Most were from Basque Country (n=222), Galicia (n=141), and Navarre (n=55). Locations of cities where hospitals are located are indicated with red dots. 92 clusters were identified. ND grouping in clusters of ≥4 individuals were 232 (51% of total). Pie charts represent proportions of ND belonging to transmission clusters of ≥4 individuals. Chart sizes are proportional to the number of ND analyzed in each region. A1 14 4 Genetic form A1 C C F1 F1 CRF01_AE CRF02_AG CRF02_AG CRF02_AG CRF02_AG CRF02_AG CRF02_AG CRF02_AG CRF19_cpx CRF47_BF BF BF BF BG BG Cluster size 35 8 14 130 15 4 32 10 8 6 4 5 4 4 14 5 5 7 33 15 358 ND 2013-2014 13 1 7 18 1 2 4 2 1 2 1 1 1 2 3 2 1 6 2 1 71 % ND in cluster 37% 13% 50% 14% 7% 50% 13% 20% 13% 33% 25% 20% 25% 50% 21% 40% 20% 86% 6% 7% 20% Figure 4. Distribution of clusters according to size and transmission among MSM. (A) Distribution of clusters by size with indication of the number of clusters associated with MSM (≥90% MSM in the cluster). (B) Distribution of clusters by size with indication of total numbers of ND individuals and of MSM within clusters of each size range. Cluster A1_1 C2 C7 F1_1 F1_2 CRF01_1 CRF02_1 CRF02_3 CRF02_6 CRF02_7 CRF02_8 CRF02_10 CRF02_11 CRF19_1 CRF47_1 CRF12B BF_2 BF_3 CRF_BG CRF14B Total Conclusions: Table 1. Data for the 20 clusters of non-subtype B genetic forms, which include total number of individuals, new diagnoses of 2013-2014, proportion of these relative to the total, and association with MSM (highlighted). A high proportion of newly diagnosed HIV-1 infections in Spain group in clusters of subtype B and non-subtype B variants, most frequently among MSM. ACKNOWLEDGEMENTS: We thank Dr. José Antonio Taboada, Consellería de Sanidade, Xunta de Galicia, and Dr. Daniel Zulaica, Unidad de Coordinación del Plan de Prevención y Control del SIDA, Osakidetza-Servicio Vasco de Salud, for their support of this study. Number of ND individuals B) 5 to 9 10 to 19 Cluster size 120 ≥20 103 100 80 61 60 56 97 40 20 0 non MSM MSM 12 34 38 5 4 5 to 9 10 to 19 Cluster size 02_AG G 22 14 4 CRF02_1 02 AG.DJ263 02 AG.CM52885 CRF02_3 02 AG.GH.-.G829 02 AG.G829 G.DRCBL G.92NG083 14 BG.X623 14 BG.X397 14 BG.X421 14 BG.X605 CRF14B A1.U455 A1.SE7253 A1.UG037 A1_1 H.VI991 H.90CF056 C.IN101 C.98BR004 C7 F1.MP0411 F1.FIN9363 F1.VI850 F1_2 F1.93BR020.1 ≥20 The recent expansion of HIV-1 clusters in many countries reflects an active dynamic of viral propagation via sexual transmission, requiring the reinforcement of public health measures aimed at the prevention of high risk sexual behavior. FUNDING: • Dirección General de Farmacia, Ministerio de Sanidad, Servicios Sociales e Igualdad, Spain, EC11-272; • European Research Infrastructures for Poverty Related Diseases (EURIPRED). 7th Framework Programme: FP7-Capacities-infrastructures-2012-1, grant # 312661; • Instituto de Salud Carlos III, Subdirección General de Evaluación, y Fondo Europeo de Desarrollo Regional (FEDER), Plan Nacional I + D + I, proyecto RD12/0017/0026; • Consellería de Sanidade, Xunta de Galicia, Spain; • Osakidetza-Servicio Vasco de Salud, Spain. C F1 F1_1 0.01 Figure 3. Maximum likelihood phylogenetic tree of PR-RT including transmission clusters of ≥10 individuals. Branches in clusters are compressed in triangles, with height proportional to the number of samples. † Spanish Group for the Study of HIV-1 Antiretroviral Drug Resistance and Tropism: Galicia: Basque Country: Other: Hospital Arquitecto Marcide. Ferrol Patricia Ordoñez Hortensia Álvarez Ana Mariño Complejo Hospitalario Universitario de A Coruña Hospital de Basurto Ramón Cisterna Mª Dolores Suárez Silvia Hernáez Hospital de Cruces Complejo Htal. De Navarra Carmen Ezpeleta Baquedano Angeles Cañizares Mª de los Angeles Castro Iglesias Hospital Lucus Augusti/Xeral Calde Maria José López Alvarez Complejo Hospitalario Universitario de Orense Jesús Corral Luis Elorduy Otazua Leyre López Soria Koldo Aguirrebengoa Carmen Hinojosa Mena-Bernal Ricardo Fernández Rodríguez Juan García Costa Raúl Rodríguez Complejo Hospitalario Universitario Xeral-Cíes de Vigo Hospital de Galdakao Hospital El Bierzo Mª José López de Goicoechea Carmen Raya Fernández José Mayo Hospital de León Sara Calleja Antolín Hospital Donostia Carlos Gustavo Cilla Eguiluz Julio Arrizabalaga Hospital Infanta Cristina. Badajoz Sonia Pérez Castro Antonio Ocampo Celia Miralles Isabel Lopez Miragaya Complejo Hospitalario Provincial de Pontevedra Matilde Trigo Daporta Rafael Ojea de Castro Julio Diz Arén José Antonio Iribarren Mª Julia Echevarría Hospital de Txagorritxu Mª Jesús Lezaun José Joaquín Portu Hospital Santiago Apóstol Andrés Canut Blasco Hospital Clínico Universitario de Valladolid Hospital Rio Hortega Carmen Ramos Sánchez Eugenio Garduño Hospital del S.E.S de Mérida Julián Sánchez Castañón Hospital de Fuenlabrada Santiago Prieto Menchero Mª Isabel García Arata