HIV-1 Subtype F1 Epidemiological Networks among Italian Heterosexual Males Are Associated with Introduction Events from South America

Lai, Alessia; Simonetti, Francesco R.; Zehender, Gianguglielmo; Luca, Andrea De; Micheli, Valeria; Meraviglia, Paola; Corsi, Paola; Bagnarelli, Patrizia; Almi, P; Zoncada, Alessia; Paolucci, Stefania; Gonnelli, A.; Colao, G; Tacconi, Danilo; Franzetti, Marco; Ciccozzi, Massimo; Zazzi, Maurizio; Balotta, Claudia

doi:10.1371/journal.pone.0042223

Cited by 16 publications

(15 citation statements)

References 23 publications

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“…Our results regarding C and F1 variants are in agreement with previous Italian data indicating a high relation between the South American strains, and those circulating in Italians and further showed that B subtype was imported from Latin American countries 27 28. Uncertainty cannot be completely avoided, as these individuals frequently travel abroad, and we cannot rule out transmission events in other countries during their permanence in Italy.…”

Section: Discussionsupporting

confidence: 91%

Contribution of transgender sex workers to the complexity of the HIV-1 epidemic in the metropolitan area of Milan

et al. 2020

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ObjectivesTransgender people are disproportionately affected by the HIV-1 epidemic. We evaluated the origin of HIV-1 variants carried by South American transgenders living in Milan by combining accurate phylogenetic methods and epidemiological data.MethodsWe collected 156 HIV-1 pol sequences obtained from transgender patients engaged in sex work (TSWs) followed between 1999 and 2015 at L. Sacco Hospital, Milan, Italy. Phylogenetic analyses were conducted by HIV-TRACE, MrBayes, MacClade and Beast programs. Reference sequences were retrieved from Los Alamos and local databases. Last negative testing or proxy data from clinical records of infected individuals were used to investigate the country of infection.ResultsAmong South American TSWs, the most represented HIV-1 subtypes were B (70.5%), F1 (12.8%) and C (4.4%). Gene flow migrations of B subtype indicated significant fluxes from TSWs to Italians (21.3%) belonging to all risk groups (26.4% to heterosexuals (HEs), 18.9% to men who have sex with men (MSM), 15.1% to injecting drug users). The largest proportion of bidirectional fluxes were observed between Italians and TSWs (24.6%). For F1 subtype, bidirectional viral fluxes involved TSWs and Italians (7.1% and 14.3%), and a similar proportion of fluxes linked TSWs and Italian HEs or MSM (both 15.8%). Significant fluxes were detected from Italians to TSWs for subtype C involving both MSM (30%) and HEs (40%). Country of HIV-1 acquisition was identified for 72 subjects; overall, the largest proportion of patients with B subtype (73.5%) acquired HIV-1 infection in South America.ConclusionsOur results indicated that South American transgenders largely contribute to the heterogeneity of HIV-1 variants in our country. The high number of clusters based on all subtypes indicated numerous transmission chains in which TSWs were constantly intermixed with HEs and MSM. Our results strongly advocate interventions to facilitate prevention, diagnosis and HIV-1 care continuum among transgender people.

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Section: Discussionsupporting

confidence: 91%

Contribution of transgender sex workers to the complexity of the HIV-1 epidemic in the metropolitan area of Milan

et al. 2020

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“…The analysis provided has the purpose to represent the evolution within a cluster of people with a strong association of predisposing and geographical factors and therefore determine relationship into the sources of an epidemic of ongoing viral spread, at the level of the population. Another large cluster was identified in F1 subtype, with 10 heterosexual Italian individuals, a finding which had already been reported for this subtype [18].…”

Section: Discussionsupporting

confidence: 73%

“…Also, in Italy, a B subtype prevalent area, some different geographically restricted non-B subtypes and CRFs are now penetrating, favored by immigration and travels [18][19][20][21]. A recent study has shown, in fact, an increase of non-B variants from 15.8% to 29.7% during the study period [22].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Non-B HIV-1 Subtypes in North Italy and Analysis of Transmission Clusters Based on Sequence Data Analysis

et al. 2019

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HIV-1 diversity is increasing in European countries due to immigration flows, as well as travels and human mobility, leading to the circulation of both new viral subtypes and new recombinant forms, with important implications for public health. We analyzed 710 HIV-1 sequences comprising protease and reverse-transcriptase (PR/RT) coding regions, sampled from 2011 to 2017, from naive patients in Spedali Civili Hospital, Brescia, Italy. Subtyping was performed by using a combination of different tools; the phylogenetic analysis with a structured coalescence model and Makarov Chain Monte Carlo was used on the datasets, to determine clusters and evolution. We detected 304 (43%) patients infected with HIV-1 non-B variants, of which only 293 sequences were available, with four pure subtypes and five recombinant forms; subtype F1 (17%) and CRF02_AG (51.1%) were most common. Twenty-five transmission clusters were identified, three of which included >10 patients, belonging to subtype CRF02_AG and subtype F. Most cases of alleged transmission were between heterosexual couples. Probably due to strong migratory flows, we have identified different subtypes with particular patterns of recombination or, as in the case of the subtype G (18/293, 6.1%), to a complete lack of relationship between the sequenced strains, revealing that they are all singletons. Continued HIV molecular surveillance is most important to analyze the dynamics of the boost of transmission clusters in order to implement public health interventions aimed at controlling the HIV epidemic.

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“…Additionally, despite the reported decrease of infections due to injecting drug usage ( http://www.iss.it/binary/ccoa/cont/ONLINE_6_COA_2014.pdf ), the circulation of A1 subtype partially remains related to this modality of infection as in previously documented A1 epidemics of East European countries [ 21 ]. In contrast with previous published data regarding other non-B subtypes circulating in Italy, such as subtype C and F1 which mobility is associated with men having sex with men, the A1 subtype remains related to heterosexuals and IDUs [ 25 , 26 ].…”

Section: Discussioncontrasting

confidence: 67%

HIV-1 A1 Subtype Epidemic in Italy Originated from Africa and Eastern Europe and Shows a High Frequency of Transmission Chains Involving Intravenous Drug Users

et al. 2016

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BackgroundSubtype A accounts for only 12% of HIV-1 infections worldwide but predominates in Russia and Former Soviet Union countries of Eastern Europe. After an early propagation via heterosexual contacts, this variant spread explosively among intravenous drug users. A distinct A1 variant predominates in Greece and Albania, which penetrated directly from Africa. Clade A1 accounts for 12.5% of non-B subtypes in Italy, being the most frequent after F1 subtype.AimAim of this study was to investigate the circulation of A1 subtype in Italy and trace its origin and diffusion through phylogenetic and phylodynamic approaches.ResultsThe phylogenetic analysis of 113 A1 pol sequences included in the Italian ARCA database, indicated that 71 patients (62.8%) clustered within 5 clades. A higher probability to be detected in clusters was found for patients from Eastern Europe and Italy (88.9% and 60.4%, respectively) compared to those from Africa (20%) (p < .001). Higher proportions of clustering sequences were found in intravenous drug users with respect to heterosexuals (85.7% vs. 59.3%, p = .056) and in women with respect to men (81.4% vs. 53.2%, p < .006). Subtype A1 dated phylogeny indicated an East African origin around 1961. Phylogeographical reconstruction highlighted 3 significant groups. One involved East European and some Italian variants, the second encompassed some Italian and African strains, the latter included the majority of viruses carried by African and Italian subjects and all viral sequences from Albania and Greece.ConclusionsSubtype A1 originated in Central Africa and spread among East European countries in 1982. It entered Italy through three introduction events: directly from East Africa, from Albania and Greece, and from the area encompassing Moldavia and Ukraine. As in previously documented A1 epidemics of East European countries, HIV-1 A1 subtype spread in Italy in part through intravenous drug users. However, Eastern European women contributed to the penetration of such variant, probably through sex work.

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HIV-1 Subtype F1 Epidemiological Networks among Italian Heterosexual Males Are Associated with Introduction Events from South America

Cited by 16 publications

References 23 publications

Contribution of transgender sex workers to the complexity of the HIV-1 epidemic in the metropolitan area of Milan

Contribution of transgender sex workers to the complexity of the HIV-1 epidemic in the metropolitan area of Milan

Prevalence of Non-B HIV-1 Subtypes in North Italy and Analysis of Transmission Clusters Based on Sequence Data Analysis

HIV-1 A1 Subtype Epidemic in Italy Originated from Africa and Eastern Europe and Shows a High Frequency of Transmission Chains Involving Intravenous Drug Users

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