Molecular Epidemiological Analysis of the Origin and Transmission Dynamics of the HIV-1 CRF01_AE Sub-Epidemic in Bulgaria
Open Access
- 16 January 2021
- Vol. 13 (1), 116
- https://doi.org/10.3390/v13010116
Abstract
HIV-1 subtype CRF01_AE is the second most predominant strain in Bulgaria, yet little is known about the molecular epidemiology of its origin and transmissibility. We used a phylodynamics approach to better understand this sub-epidemic by analyzing 270 HIV-1 polymerase (pol) sequences collected from persons diagnosed with HIV/AIDS between 1995 and 2019. Using network analyses at a 1.5% genetic distance threshold (d), we found a large 154-member outbreak cluster composed mostly of persons who inject drugs (PWID) that were predominantly men. At d = 0.5%, which was used to identify more recent transmission, the large cluster dissociated into three clusters of 18, 12, and 7 members, respectively, five dyads, and 107 singletons. Phylogenetic analysis of the Bulgarian sequences with publicly available global sequences showed that CRF01_AE likely originated from multiple Asian countries, with Vietnam as the likely source of the outbreak cluster between 1988 and 1990. Our findings indicate that CRF01_AE was introduced into Bulgaria multiple times since 1988, and infections then rapidly spread among PWID locally with bridging to other risk groups and countries. CRF01_AE continues to spread in Bulgaria as evidenced by the more recent large clusters identified at d = 0.5%, highlighting the importance of public health prevention efforts in the PWID communities.Keywords
This publication has 54 references indexed in Scilit:
- The rapidly expanding CRF01_AE epidemic in China is driven by multiple lineages of HIV-1 viruses introduced in the 1990sAIDS, 2013
- HIV-1 Clade B pol Evolution following Primary InfectionPLOS ONE, 2013
- aLeaves facilitates on-demand exploration of metazoan gene family trees on MAFFT sequence alignment server with enhanced interactivityNucleic Acids Research, 2013
- Detailed Molecular Epidemiologic Characterization of HIV-1 Infection in Bulgaria Reveals Broad Diversity and Evolving PhylodynamicsPLOS ONE, 2013
- Origins of HIV and the AIDS PandemicCold Spring Harbor Perspectives in Medicine, 2011
- FastTree 2 – Approximately Maximum-Likelihood Trees for Large AlignmentsPLOS ONE, 2010
- jpHMM: Improving the reliability of recombination prediction in HIV-1Nucleic Acids Research, 2009
- Genetic Characterization of CRF01_AE Full-Length Human Immunodeficiency Virus Type 1 Sequences from Fujian, ChinaAIDS Research and Human Retroviruses, 2007
- Global epidemiology of HIVJournal of Medical Virology, 2006
- MUSCLE: multiple sequence alignment with high accuracy and high throughputNucleic Acids Research, 2004