The HIV Type 1 Epidemic in Bulgaria Involves Multiple Subtypes and Is Sustained by Continuous Viral Inflow from West and East European Countries

Salemi, Marco; Goodenow, Maureen M.; Montieri, Stefania; Oliveira, Túlio de; Santoro, Maria Mercedes; Beshkov, Danail; Alexiev, Ivailo; Elenkov, Ivailo; Elenkov, I.; Yakimova, Tsvetana; Varleva, Tonka; Rezza, Giovanni; Ciccozzi, Massimo

doi:10.1089/aid.2007.0181

Cited by 34 publications

(36 citation statements)

References 27 publications

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“…Specifically, A clade spread as a result of a founder effect from the A clade epidemic in neighbouring Greece (Paraskevis et al, 2007;Salemi et al, 2008a). In Bulgaria, there are several HIV-1 clades circulating and as it has been shown clades B and A1 were introduced by at least three or four independent sources in last 25 years (Salemi et al, 2008b). Although B clade still predominates, with higher prevalence among women and PWID, there are several clades (A1, B, C, F1 and H) and CRFs (namely CRFs; 01_AE, 02_AG, 04_cpx, 05_DF, 14_BG, and 36_cpx) circulating among MSM and PWID, increasing the HIV-1 epidemic heterogeneity Ivanov et al, 2013).…”

Section: Central Europementioning

confidence: 99%

Molecular epidemiology of HIV-1 infection in Europe: An overview

Beloukas

Psarris

Giannelou

et al. 2016

Infection, Genetics and Evolution

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Section: Central Europementioning

confidence: 99%

Molecular epidemiology of HIV-1 infection in Europe: An overview

Beloukas

Psarris

Giannelou

et al. 2016

Infection, Genetics and Evolution

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“…The phylogenetic analysis 5 Sixty-two out of 80 (77.5%) patients had their first HIV-1 determination before age 40 years, but there was no obvious evidence about different distributions of subtypes by age. Male gender was significantly prevalent in patients infected with subtype B (33/41, 80.5%) in comparison with the patients infected with subtype A, who were predominantly females (11/18, 61.1%) (p ϭ 0.002), and the patients infected with other subtypes (male gender: 12/21, 57.1%) (p ϭ 0.072).…”

mentioning

confidence: 97%

“…HIV-1 subtypes were determined by phylogenetic analysis of pol region sequences. 5 The nucleotide sequences obtained in this study have been submitted to GenBank under accession numbers EF517409-EF517489.…”

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confidence: 99%

Short Communication:Characterization of Drug-Resistance Mutations in HIV Type 1 Isolates from Drug-Naive and ARV-Treated Patients in Bulgaria

Santoro

Ciccozzi

Alteri

et al. 2008

AIDS Research and Human Retroviruses

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Little information is available about the prevalence of resistance mutations to reverse transcriptase (RT) and protease (PR) inhibitors of HIV-1, after the introduction of antiretroviral treatment in Bulgaria. To fill this gap, we analyzed 80 plasma samples from HIV-1-infected Bulgarian patients, 22 naive at antiretroviral treatment (ARV) and 58 ARV experienced. The subtypes B and A resulted in the two most prevalent (41 patients and 18 patients, respectively). The proportion of subtype B among naive and treated patients was similar in each group (57% vs. 47%, p ϭ 0.62), while a major proportion of subtypes A was present in drug-naive patients rather than in treated patients [8/22 (36.4%) vs. 10/58 (17.2%), p ϭ 0.08]. Two (9.1%) naive patients and 40 (70.1%) drugexperienced patients had viruses carrying at least one mutation conferring resistance to ARV drugs. Of 57 patients having experience with nucleoside reverse transcriptase inhibitors (NRTI), 32 (56.1%) had NRTI resistance mutations; 8/14 (57.2%) patients having experience with non-NRTI (NNRTI) had viruses carrying NNRTI resistance mutations; and 21/46 (45.7%) patients having experience with protease inhibitors (PI) had PI resistance mutations. The commonest resistance mutations resulted in the NRTI mutation M184V (42.1%) and the PI mutation L90M (24.1%). In conclusion, due to the detection of the substantial transmission of resistant variants to newly infected individuals, continuous surveillance is required, since greater access to highly active antiretroviral therapy (HAART) will be expected in Bulgaria. Furthermore, surveillance of PR and RT sequences is also convenient to monitor the introduction of nonsubtype B HIV-1 strains in Bulgaria. 1133

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“…New infectious diseases are emerging, old diseases are reappearing (e.g., tuberculosis, West Nile Fever etc. ), and incidences for many diseases are rising (e.g., HIV and other sexually transmitted infections) (1–5). Much of this evolving disease burden began in the early 1990s, when transition toward a market economy led to widespread social unrest and when civil wars in the region displaced large numbers of people and created populations that were vulnerable to communicable diseases and difficult to reach through existing health care systems (6–9).…”

Section: Introductionmentioning

confidence: 99%

Southeastern European Health Network (SEEHN) Communicable Diseases Surveillance: A Decade of Bridging Trust and Collaboration

Bino

Čavaljuga

Kunchev³

et al. 2013

Emerging Health Threats Journal

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The communicable disease threats and changes that began emerging in south-east Europe in the early 1990s – after a decade of war and while political and health systems region-wide were undergoing dramatic changes – demanded a novel approach to infectious disease surveillance. Specifically, they called for an approach that was focused on cross-border collaboration and aligned with European Union standards and requirements. Thus, the Southeastern European Health network (SEEHN) was established in 2001 as a cooperative effort among the governments of Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Moldova, Montenegro, Romania, Serbia, and the former Yugoslav Republic of Macedonia. In 2002, SEEHN initiated a communicable diseases project aimed at strengthening both national and regional surveillance systems with a focus on cross-border collaboration. Over time, SEEHN has nurtured growth of a regional fabric of SEE experts in communicable diseases surveillance and response who are able to discuss emerging issues and best practices at any time and without being constrained by the rigidity of traditional or existing systems. Main achievements to date include joint preparation of influenza pandemic preparedness plans at both national and regional levels and the introduction of molecular techniques into influenza surveillance laboratories region-wide. Here, we describe the history of the SEEHN communicable disease project; major activities and accomplishments; and future sustainability of the regional infectious disease surveillance network that has emerged and grown over the past decade.

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The HIV Type 1 Epidemic in Bulgaria Involves Multiple Subtypes and Is Sustained by Continuous Viral Inflow from West and East European Countries

Abstract: Little is known about the HIV-1 epidemic in Balkan countries.

Cited by 34 publications

References 27 publications

Molecular epidemiology of HIV-1 infection in Europe: An overview

Molecular epidemiology of HIV-1 infection in Europe: An overview

Short Communication:Characterization of Drug-Resistance Mutations in HIV Type 1 Isolates from Drug-Naive and ARV-Treated Patients in Bulgaria

Southeastern European Health Network (SEEHN) Communicable Diseases Surveillance: A Decade of Bridging Trust and Collaboration

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