Emergence as an outbreak of the HIV-1 CRF19_cpx variant in treatment-naïve patients in southern Spain

CRF19_cpx is a complex circulating recombination form (CRF) of HIV-1. We describe the characteristics of an outbreak of the CRF19_cpx variant among treatment-naïve patients in southern Spain. The study was undertaken at the Virgen de la Victoria Hospital, a reference centre for the analysis of HIV-1...

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Bibliographic Details
Published in:	PloS one Vol. 13; no. 1; p. e0190544
Main Authors:	González-Domenech, Carmen M, Viciana, Isabel, Delaye, Luis, Mayorga, María Luisa, Palacios, Rosario, de la Torre, Javier, Jarilla, Francisco, Castaño, Manuel, Del Arco, Alfonso, Clavijo, Encarnación, Santos, Jesús
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 01-01-2018 Public Library of Science (PLoS)
Subjects:	Acquired immune deficiency syndrome Adult AIDS Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Bayes Theorem Bayesian analysis Biology and Life Sciences Biomedical research CD4 Lymphocyte Count Cohort Studies Computer and Information Sciences Demographics Disease Outbreaks Disease transmission Drug resistance Epidemics Epidemiology Female Genotype Genotypes HIV HIV Infections - epidemiology HIV Infections - virology HIV-1 - classification HIV-1 - genetics Human immunodeficiency virus Humans Infectious diseases Internal medicine Male Maximum likelihood method Medicine and Health Sciences Mutation Outbreaks Patients People and places Phylogenetics Phylogeny Recombination Research and Analysis Methods RNA-directed DNA polymerase Sexually transmitted diseases Spain - epidemiology Statistical inference STD Viral Load Young Adult
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Summary:	CRF19_cpx is a complex circulating recombination form (CRF) of HIV-1. We describe the characteristics of an outbreak of the CRF19_cpx variant among treatment-naïve patients in southern Spain. The study was undertaken at the Virgen de la Victoria Hospital, a reference centre for the analysis of HIV-1 genotype in Malaga (Spain). Subtyping was performed through REGA v3.0 and the relationship of our CRF19_cpx sequences, among themselves and regarding other reference sequences from the same variant, was defined by phylogenetic analysis. We used PhyML program to perform a reconstruction of the phylogeny by Maximum Likelihood method as well as further confirmation of the transmission clusters by Bayesian inference. Additionally, we collected demographic, clinical and immunovirological data. Between 2011 and 2016, we detected 57 treatment-naïve patients with the CRF19_cpx variant. Of these, 55 conformed a very well-defined transmission cluster, phylogenetically close to CRF19_cpx sequences from the United Kingdom. The origin of this subtype in Malaga was dated between 2007 and 2010. Over 50% of the patients presented the non-nucleoside reverse transcriptase inhibitor G190A resistance mutation. This variant was mostly represented by young adult Spanish men who had sex with men. Almost half of them were recent seroconverters, though a similar percentage was diagnosed at a late state of HIV infection. Five cases of AIDS and one non-AIDS defined death occurred during follow-up. The majority of patients treated with first-line combination antiretroviral therapy (ART) responded. We report the largest HIV-1 CRF19_cpx cohort of treatment-naïve patients outside Cuba, almost all emerging as an outbreak in the South of Spain. Half the cases had the G190A resistance mutation. Unlike previous studies, the variant from Malaga seems less pathogenic, with few AIDS events and an excellent response to ART.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: There is no conflict of interest.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0190544