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Kristel Van Laethem on behalf of the AIDS Reference Laboratories
HIV-1 subtypes in BelgiumSub-subtype F1 outbreak among MSM in Belgium
Global prevalence HIV-1 group M subtypes (%)A 12,0
B 11,3
C 48,2
D 2,5F 0,5
G 4,6
CRF01_AE 5,1
CRF02_AG 7,7
other 8,1
2004-2007
Hemelaar et al. 2011
Regional prevalence HIV-1 group M subtypes (%)
A
B
C
D
F
G
CRF01_AE
CRF02_AG
other
2004-2007
Hemelaar et al. 2011
69%
6.5 %
9%
15.5%1x106
HIV-1 group M subtypes in Belgium
B MSM B MSM B MSM
Caucasian
non-B
hetero
Africandiagnosis year
B
MSMCaucasian
HCV Chlamydia
Associations
Prevalence subtypes
1985 20051995 2015
1 3 4 52
100%
50%
STP + KUL in 1983-2001 (n=281) UG in 2001-2009 (n=506) KUL in 1998-2012 (n=778)
BE in 2003-2006 (n=285)
2 4
3
5ITG in 1985-1994 (n=190)1
100%
50%
100%
50%
100%
50%
100%
50%
100%
50%
100%
50%
1983 2001
Belgians
Belgian MSM
Fransen et al. 1996 Snoeck et al. 2004 Chalmet et al. 2010 Pineda-Peña et al. 2014
Vercauteren et al. 2008
Time trends distribution subtypes (BE – ARL)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2008 2009 2013 2014
other
CRF02
CRF01
G
F
D
C
B
A
drug resistance testing (n2013=650, n2014=551)newly diagnosed and therapy-naïve patientsunpublished (by courtesy of Chris Verhofstede)
drug resistance testing (n2008=395, n2009=669)first consult at clinical centreMuyldermans et al. 2014
Gender distribution among subtypes (BE – ARL)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
A B C D F G CRF01 CRF02 other
M F
2013-2014
Demographics sub-subtype F1 (BE – ARL, n=293)
0
10
20
30
40
50
60
70
80
90
unknown ….-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 2011-2012 2013-2014
< 25 years (M) 25 - 39 years (M) > 39 years (M) unknown (M)
< 25 years (F) 25 - 39 years (F) > 39 years (F) unknown (F)
8%
42%
23%
3%
5%
10%
6% 3%
Probable transmission route sub-subtype F1 (M, n=226)
0
10
20
30
40
50
60
70
80
unknown ….-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 2011-2012 2013-2014
MSM bisexual heterosexual unknown
52%
15%
15%
18%
Probable country of infection sub-subtype F1 (M)
54%
38%
Belgium
Romania
Spain
Europe
Brazil
Africa
Asia
Unknown
Geographical distribution (test site) sub-subtype F1 (M)
0
10
20
30
40
50
60
70
80
unknown ….-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 2011-2012 2013-2014
ITG KUL UG VUB STP UCL ULB
53%
15%
8%
3%
12%
7% 2%
Data collection – International context
o Europe Collaborators Los Alamos database
o Los Alamos databaseAfrica
Cape Verde, Angola, Cameroon,DRC, Gabon, Nigeria
AsiaJapan, Russa, China
North-AmericaUSA, Cuba, Canada, HondurasPanama
South-AmericaBrazil, Argentina, Chile, Colombia
Phylogenetic tree sub-subtype F1 (sampling country)
Brazil, Romania, Belgium, Spain, Portugal, Italy
Phylogenetic tree sub-subtype F1 (country + risk)
Brazil, Romania, Belgium, Spain, Portugal, Italy MSM, bisexual, heterosexual, IVDU, unknown
Planned experiments
o To reconstruct the evolutionary and demographic history of HIV-1 sub-subtype F1 To determine the spatiotemporal origin
To identify epidemiological links among locations and risk groups, and quantify virus exchange
To estimate population dynamics
Conclusions and potential implications
o The traditional geographical and risk group segregation of HIV-1 subtypes are becoming less distinct
o Actively propagating transmission network of sub-subtype F1 among MSM in Belgium
o Subtype F1 was independently associated with a reduced virologicalresponse at 24 weeks in Spain (Pernas et al. 2014)
Acknowledgements
o AIDS Reference Laboratories Katrien Fransen, Marc Van Ranst, Chris Verhofstede, Denis Piérard, Marie-Luce
Delforge, Jean Ruelle and their teams
o KU Leuven Lore Vinken, Andrea Pineda-Peña, Philippe Lemey, Anne-Mieke Vandamme,
Yoeri Schrooten, Fossie Ferreira, Lize Cuypers
o International collaboratorsMurat Sayan (Turkey), Ivailo Alexiev (Bulgaria), Simona Paraschiv (Romania),
Carole Devaux (Luxembourg), Perpetua Gomes (Portugal), Martine Peeters (Angola), Claudia Balotta (Italy), Francesca Incardona (EuResist – Sweden, Germany, Spain, Hungary, Russia, Israel)