No abstract

HIV-1 strain diversity in Bulgaria is extensive and includes contributions from nearly all major subtypes and the Circulating Recombinant Forms (CRF): 01_AE, 02_AG, and 05_DF. Prior to this study, HIV-1 sequence information from Bulgaria has been based solely on the pro-RT gene, which represent less than 15% of the viral genome. To further characterize HIV-1 in Bulgaria, assess participant risk behaviors, and strengthen knowledge of circulating strains in the region, the study “Genetic Subtypes of HIV-1 in Bulgaria (RV240)” was conducted. This study employed the real time-PCR based Multi-region Hybridization Assay (MHA) B/non-B and HIV-1 sequencing to survey 215 of the approximately 1100 known HIV-1 infected Bulgarian adults (2008–2009) and determine if they were infected with subtype B HIV-1. The results indicated a subtype B prevalence of 40% and demonstrate the application of the MHA B/non-B in an area containing broad HIV-1 strain diversity. Within the assessed risk behaviors, the proportion of subtype B infection was greatest in men who have sex with men and lowest among those with drug use risk factors. During this study, 15 near full-length genomes and 22 envelope sequences were isolated from study participants. Phylogenetic analysis shows the presence of subtypes A1, B, C, F1, and G, CRF01_AE, CRF02_AG, CRF05_DF, and one unique recombinant form (URF). These sequences also show the presence of two strain groups containing participants with similar risk factors. Previous studies in African and Asian cohorts have shown that co-circulation of multiple subtypes can lead to viral recombination within super-infected individuals and the emergence of new URFs. The low prevalence of URFs in the presence of high subtype diversity in this study, may be the result of successful infection prevention and control programs. Continued epidemiological monitoring and support of infection prevention programs will help maintain control of the HIV-1 epidemic in Bulgaria.

Dur ing the first years as a mem ber to the Eu ro pean Un ion the healthcare sys tem of Re pub lic of Bul garia faced many chal lenges: de clin ing de mo graphic ten den cies, pov erty with no tice ably ex pressed age di men sions and lim ited re sources for health care. The aim of this study is to re veal some so cial de ter mi nants and risk fac tors in the vul ner a ble groups of el derly peo ple and breast-fed in fants with com mu ni ca ble dis eases. Spe cially designed ques tion naires were used to study the so cio eco nomic and other risk fac tors in pa tients over 60 years and moth ers ac com pa ny ing their in fants with in fec tious dis eases. Anal y ses of the de mo graphic in di ca tors of Varna re gion and dis ease in ci dence cor re spond to the trends of the na tional level. In fec tious dis eases most com monly ob served among the aged pop u la tion are shigelloses, salmonelloses and other gastroenterites, Med i ter ra nean spot ted fe ver, lymeborreliosis, acute vi ral hep a ti tis and neuroinfections. Gastroenterites in breast-fed in fants are the most com mon cause for hos pi tal iza tion. The risk fac tors in flu enc ing pa tients of 60+ suf fer ing from in fec tious dis eases are pov erty, un healthy and in ad e quate nu tri tion, smok ing, al co hol consump tion, in suf fi cient phys i cal ac tiv ity and high lev els of stress. So cially sig nif i cant in com mu ni ca ble dis eases are the com mon ter rain on which the in fec tious pro cess takes place. Risk fac tors in flu enc ing in fants with infec tious dis eases are sim i lar and some times de rived from the fac tors in flu enc ing the adult pop u la tion. More de tailed and wider span stud ies of the so cial de ter mi nants of comunicable dis eases in Bul garia are needed to es ti mate the sit u a tion in other risk groups.