PMID- 37112921
OWN - NLM
STAT- MEDLINE
DCOM- 20230501
LR  - 20230501
IS  - 1999-4915 (Electronic)
IS  - 1999-4915 (Linking)
VI  - 15
IP  - 4
DP  - 2023 Apr 10
TI  - Transmitted HIV Drug Resistance in Bulgaria Occurs in Clusters of Individuals 
      from Different Transmission Groups and Various Subtypes (2012-2020).
LID - 10.3390/v15040941 [doi]
LID - 941
AB  - Transmitted HIV drug resistance in Bulgaria was first reported in 2015 using data 
      from 1988-2011. We determined the prevalence of surveillance drug resistance 
      mutations (SDRMs) and HIV-1 genetic diversity in Bulgaria during 2012-2020 using 
      polymerase sequences from 1053 of 2010 (52.4%) antiretroviral therapy (ART)-naive 
      individuals. Sequences were analyzed for DRM using the WHO HIV SDRM list 
      implemented in the calculated population resistance tool at Stanford University. 
      Genetic diversity was inferred using automated subtyping tools and phylogenetics. 
      Cluster detection and characterization was performed using MicrobeTrace. The 
      overall rate of SDRMs was 5.7% (60/1053), with 2.2% having resistance to 
      nucleoside reverse transcriptase inhibitors (NRTIs), 1.8% to non-nucleoside 
      reverse transcriptase inhibitors (NNRTIs), 2.1% to protease inhibitors (PIs), and 
      0.4% with dual-class SDRMs. We found high HIV-1 diversity, with the majority 
      being subtype B (60.4%), followed by F1 (6.9%), CRF02_AG (5.2%), A1 (3.7%), 
      CRF12_BF (0.8%), and other subtypes and recombinant forms (23%). Most (34/60, 
      56.7%) of the SDRMs were present in transmission clusters of different subtypes 
      composed mostly of male-to-male sexual contact (MMSC), including a 14-member 
      cluster of subtype B sequences from 12 MMSC and two males reporting heterosexual 
      contact; 13 had the L90M PI mutation and one had the T215S NRTI SDRM. We found a 
      low SDRM prevalence amid high HIV-1 diversity among ART-naive patients in 
      Bulgaria during 2012-2020. The majority of SDRMs were found in transmission 
      clusters containing MMSC, indicative of onward spread of SDRM in drug-naive 
      individuals. Our study provides valuable information on the transmission dynamics 
      of HIV drug resistance in the context of high genetic diversity in Bulgaria, for 
      the development of enhanced prevention strategies to end the epidemic.
FAU - Alexiev, Ivailo
AU  - Alexiev I
AUID- ORCID: 0000-0002-3186-1124
AD  - National Reference Laboratory of HIV, National Center of Infectious and Parasitic 
      Diseases (NCIPD), 1504 Sofia, Bulgaria.
FAU - Shankar, Anupama
AU  - Shankar A
AD  - Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB 
      Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
FAU - Pan, Yi
AU  - Pan Y
AD  - Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB 
      Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
FAU - Grigorova, Lyubomira
AU  - Grigorova L
AD  - National Reference Laboratory of HIV, National Center of Infectious and Parasitic 
      Diseases (NCIPD), 1504 Sofia, Bulgaria.
FAU - Partsuneva, Alexandra
AU  - Partsuneva A
AD  - National Reference Laboratory of HIV, National Center of Infectious and Parasitic 
      Diseases (NCIPD), 1504 Sofia, Bulgaria.
FAU - Dimitrova, Reneta
AU  - Dimitrova R
AUID- ORCID: 0000-0001-7711-6798
AD  - National Reference Laboratory of HIV, National Center of Infectious and Parasitic 
      Diseases (NCIPD), 1504 Sofia, Bulgaria.
FAU - Gancheva, Anna
AU  - Gancheva A
AD  - National Reference Laboratory of HIV, National Center of Infectious and Parasitic 
      Diseases (NCIPD), 1504 Sofia, Bulgaria.
FAU - Kostadinova, Asya
AU  - Kostadinova A
AD  - National Reference Laboratory of HIV, National Center of Infectious and Parasitic 
      Diseases (NCIPD), 1504 Sofia, Bulgaria.
FAU - Elenkov, Ivaylo
AU  - Elenkov I
AD  - Specialized Hospital for Active Treatment of Infectious & Parasitic Diseases, 
      1606 Sofia, Bulgaria.
FAU - Yancheva, Nina
AU  - Yancheva N
AUID- ORCID: 0000-0002-0095-263X
AD  - Specialized Hospital for Active Treatment of Infectious & Parasitic Diseases, 
      1606 Sofia, Bulgaria.
FAU - Grozdeva, Rusina
AU  - Grozdeva R
AD  - Specialized Hospital for Active Treatment of Infectious & Parasitic Diseases, 
      1606 Sofia, Bulgaria.
FAU - Strashimirov, Dimitar
AU  - Strashimirov D
AD  - Specialized Hospital for Active Treatment of Infectious & Parasitic Diseases, 
      1606 Sofia, Bulgaria.
FAU - Stoycheva, Mariana
AU  - Stoycheva M
AD  - Department of Infectious Diseases, Medical University, 4002 Plovdiv, Bulgaria.
FAU - Baltadzhiev, Ivan
AU  - Baltadzhiev I
AD  - Department of Infectious Diseases, Medical University, 4002 Plovdiv, Bulgaria.
FAU - Doichinova, Tsetsa
AU  - Doichinova T
AD  - Department of Infectious Diseases, Medical University, 5800 Pleven, Bulgaria.
FAU - Pekova, Lilia
AU  - Pekova L
AD  - Clinic of Infectious Diseases, Medical University, 6000 Stara Zagora, Bulgaria.
FAU - Kosmidis, Minas
AU  - Kosmidis M
AD  - Clinic of Infectious Diseases, Medical University, 9002 Varna, Bulgaria.
FAU - Emilova, Radoslava
AU  - Emilova R
AUID- ORCID: 0000-0002-0018-1361
AD  - National Reference Laboratory of Immunology, National Center of Infectious and 
      Parasitic Diseases (NCIPD), 1504 Sofia, Bulgaria.
FAU - Nikolova, Maria
AU  - Nikolova M
AD  - National Reference Laboratory of Immunology, National Center of Infectious and 
      Parasitic Diseases (NCIPD), 1504 Sofia, Bulgaria.
FAU - Switzer, William M
AU  - Switzer WM
AUID- ORCID: 0000-0003-4591-8731
AD  - Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB 
      Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20230410
PL  - Switzerland
TA  - Viruses
JT  - Viruses
JID - 101509722
RN  - 0 (Reverse Transcriptase Inhibitors)
RN  - 3493-12-7 (methionylmethylsulfonium chloride)
RN  - 0 (Anti-HIV Agents)
SB  - IM
MH  - Humans
MH  - Male
MH  - Reverse Transcriptase Inhibitors/therapeutic use
MH  - Bulgaria/epidemiology
MH  - Drug Resistance, Viral/genetics
MH  - Mutation
MH  - *HIV Infections/drug therapy/epidemiology
MH  - *HIV Seropositivity
MH  - *HIV-1/genetics
MH  - Prevalence
MH  - Phylogeny
MH  - Genotype
MH  - *Anti-HIV Agents/pharmacology/therapeutic use
PMC - PMC10146724
OTO - NOTNLM
OT  - HIV-1
OT  - male-to-male sexual contact
OT  - subtypes
OT  - transmission clusters
OT  - transmitted drug resistance
COIS- The authors declare no conflict of interest. The funding sponsors had no role in 
      the design of the study; in the collection, analyses, or interpretation of data; 
      in the writing of the manuscript, and in the decision to publish the results.
EDAT- 2023/04/28 06:41
MHDA- 2023/05/01 06:42
PMCR- 2023/04/10
CRDT- 2023/04/28 01:54
PHST- 2023/02/12 00:00 [received]
PHST- 2023/04/04 00:00 [revised]
PHST- 2023/04/08 00:00 [accepted]
PHST- 2023/05/01 06:42 [medline]
PHST- 2023/04/28 06:41 [pubmed]
PHST- 2023/04/28 01:54 [entrez]
PHST- 2023/04/10 00:00 [pmc-release]
AID - v15040941 [pii]
AID - viruses-15-00941 [pii]
AID - 10.3390/v15040941 [doi]
PST - epublish
SO  - Viruses. 2023 Apr 10;15(4):941. doi: 10.3390/v15040941.