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

Data collection F1 – Aids Reference Laboratories

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 (risk group)

MSM, bisexual, heterosexual, IVDU, unknown

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)

Financial support

G.0692.14N

PF/10/018

Status at diagnosis 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

acute recent chronic AIDS unknown