Mapping the migration of HIV-1 among IDUs in Western Europe based on phylogenetic and

epidemiological data

Amsterdam

EdinburghGlasgow

ParisGeneva

Innsbruck

AlicanteRome

CastellonTurin

NiceMarseilles

E. Op de Coul, M. Prins, M. Cornelissen, A. van der Schoot, R. Coutinho, F. Boufassa, R. Brettle. I. Hernandez-Aguado, V. Schiffer, J. McMenamin, G. Rezza, R. Robertson, R. Zangerle, J. Goudsmit, V. Lukashov

Research questions:

Are there epidemiological links between the HIV-1 epidemics among IDUs in 7 European countries? And are they changing over time?

Do IDUs in different European countries carry similar or distinct viruses?

Are those epidemics caused by a single or multiple virus introductions?

Methods:

sequencing of the env V3 region (276 nt) genetic analysis of nucleotide sequences

Individuals classified by year of HIV seroconversion

‘84 - ’88 ‘89 - ’92

Total 37 60 50

Total

147

Austria 3 3 9

France 7 13 -

Italy 7 10 3

the Netherlands 9 9 11

Scotland 5 11 13

Spain 4 10 11

Switzerland 2 4 3

15

20

20

29

29

25

9

‘ 93

GENETIC DIFFERENCES BETWEEN VIRUSES FROM HOMOSEXUAL MEN AND DRUG USERS

IN THE NETHERLANDS

CTRPNNNTRKSIHIG PG R

AFYATGDIIGDIRQAHC

GPGR

GGC GGA or GGG

IDUs homosexual

men

conserved within a host

V3

Genetic distances (median + range)

Amsterdam Edinburgh

0.0

0.1

0.2

0.3

0.0980.111

0.269

0.209

P=0.0001

Proportion of GGC viruses (GGC/total sequences)

‘89-’92 ‘93

‘84-’88

Northern EuropeThe Netherlands 100 78 64Scotland 100 100 83

Central EuropeAustria 100 83 40France - northern 75 25 -Switzerland 50 0 0

Southern Europe France - southern 0 0 -Spain 0 27 18Italy 83 36 100

Distribution of GGC and non-GGCHIV-1 subtype B viruses

GGC

GGC

non-GGC

non - GGC

Conclusions (1):

1. At least two different virus populations have been initially introduced in IDUs in Europe.

2. The epidemic among IDUs in Northern Europe started with GGC viruses, whereas the epidemic in Southern Europe started with non-GGC viruses.

3. This geographical separation is becoming less prominent during the course of the epidemic, which indicates introductions of new viruses, in particular as a result of virus exchange between IDU populations.

Conclusions (2):

5. In Scotland, France and Italy subclusters of related viruses (‘founder’ viruses) could be observed, indicating that particular HIV variants spread further within these IDU populations.

6. For the Netherlands, Austria and Switzerland we could not observe clusters of related viruses. The heterogeneity of these virus populations indicates that the IDU populations are intermixing either with other risk groups or with drug users from other parts of Europe.

Participating sites (and representatives):

Edinburgh - Scotland Muirhouse Medical group J. Robertson, S. Burns

Western General hospital A. Richardson, R. Brettle

Glasgow - Scotland

The University of Glasgow: J. McMenamin, S. Cameron, J. Goldberg

Geneva - Switzerland University hospital: B. Hirschel, B. Broers, V. Schiffer, L. Perrin

Innsbruck - Austria Univers.kl für Derm. und Venerologie: R. Zangerle

Alicante - Spain I. Hernandez-Aguado, D. Plaza, R. Moreno University of Alicante F. Pardo

Paris - France Hôpital de Bicêtre F. Boufassa , L. Meyer, C. Rouzioux Amsterdam - the Netherlands Municipal Health Service: E. Op de Coul, M. Prins, R. Coutinho Academic Medical Center: V. Lukashov, M. Cornelissen,

A. van der Schoot, J. Goudsmit

Rome - Italy Instituto Superiorei di Sanita: G. Rezza, M. Andreoni