1887
Surveillance Open Access
Like 0

Abstract

Background

The global distribution of HIV-1 subtypes is evolving, which is reflected in the Swedish HIV cohort. The subtype HIV-1A6, which may be prone to developing resistance to cabotegravir, is the most common subtype in Ukraine.

Aim

We aimed to examine trends in HIV-1 subtype distribution in Sweden, with a special focus on HIV-1A6, and to describe the virology, demography and treatment of Ukrainian people living with HIV (PLWH) who migrated to Sweden in 2022.

Methods

Data about PLWH in Sweden are included in a national database (InfCareHIV). We used the online tool COMET to establish HIV-1 subtypes and the Stanford database to define drug resistance mutations. We investigated the relation between virological characteristics and demographic data.

Results

The early epidemic was predominated by HIV-1 subtype B infections in people born in Sweden. After 1990, the majority of new PLWH in Sweden were PLWH migrating to Sweden, resulting in an increasingly diverse epidemic. In 2022, HIV-1A6 had become the sixth most common subtype in Sweden and 98 of the 431 new PLWH that were registered in Sweden came from Ukraine. We detected HIV RNA in plasma of 32 Ukrainian patients (34%), of whom 17 were previously undiagnosed, 10 had interrupted therapy and five were previously diagnosed but not treated. We found HIV-1A6 in 23 of 24 sequenced patients.

Conclusion

The molecular HIV epidemiology in Sweden continues to diversify and PLWH unaware of their HIV status and predominance of HIV-1A6 should be considered when arranging care directed at PLWH from Ukraine.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2023.28.48.2300224
2023-11-30
2024-03-02
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2023.28.48.2300224
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/28/48/eurosurv-28-48-2.html?itemId=/content/10.2807/1560-7917.ES.2023.28.48.2300224&mimeType=html&fmt=ahah

References

  1. Hemelaar J, Elangovan R, Yun J, Dickson-Tetteh L, Fleminger I, Kirtley S, et al. Global and regional molecular epidemiology of HIV-1, 1990-2015: a systematic review, global survey, and trend analysis. Lancet Infect Dis. 2019;19(2):143-55.  https://doi.org/10.1016/S1473-3099(18)30647-9  PMID: 30509777 
  2. Joint United Nations Programme on HIV/AIDS (UNAIDS). In danger: UNAIDS global AIDS update 2022. Geneva: UNAIDS; 2022. Licence: CC BY-NC-SA 3.0 IGO. Available from: https://www.unaids.org/en/resources/documents/2022/in-danger-global-aids-update
  3. Vasylyev M, Skrzat-Klapaczyńska A, Bernardino JI, Săndulescu O, Gilles C, Libois A, et al. Unified European support framework to sustain the HIV cascade of care for people living with HIV including in displaced populations of war-struck Ukraine. Lancet HIV. 2022;9(6):e438-48.  https://doi.org/10.1016/S2352-3018(22)00125-4  PMID: 35576942 
  4. van de Klundert MAA, Antonova A, Di Teodoro G, Ceña Diez R, Chkhartishvili N, Heger E, et al. Molecular epidemiology of HIV-1 in Eastern Europe and Russia. Viruses. 2022;14(10):2099.  https://doi.org/10.3390/v14102099  PMID: 36298654 
  5. Public Health Agency of Sweden (FOHM). HIV and STIs. Stockholm: FOHM; 2023. Available from: https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/living-conditions-and-lifestyle/hiv-and-stis
  6. Sönnerborg A, Durdevic S, Giesecke J, Sällberg M. Dynamics of the HIV-1 subtype distribution in the Swedish HIV-1 epidemic during the period 1980 to 1993. AIDS Res Hum Retroviruses. 1997;13(4):343-5.  https://doi.org/10.1089/aid.1997.13.343  PMID: 9071434 
  7. Bontell I, Häggblom A, Bratt G, Albert J, Sönnerborg A. Trends in antiretroviral therapy and prevalence of HIV drug resistance mutations in Sweden 1997-2011. PLoS One. 2013;8(3):e59337.  https://doi.org/10.1371/journal.pone.0059337  PMID: 23533618 
  8. Neogi U, Häggblom A, Santacatterina M, Bratt G, Gisslén M, Albert J, et al. Temporal trends in the Swedish HIV-1 epidemic: increase in non-B subtypes and recombinant forms over three decades. PLoS One. 2013;8(3):e59337.  https://doi.org/10.1371/journal.pone.0099390  PMID: 24922326 
  9. Carlander C, Brännström J, Månsson F, Elvstam O, Albinsson P, Blom S, et al. Cohort profile: InfCareHIV, a prospective registry-based cohort study of people with diagnosed HIV in Sweden. BMJ Open. 2023;13(3):e069688.  https://doi.org/10.1136/bmjopen-2022-069688  PMID: 36931676 
  10. Cutrell AG, Schapiro JM, Perno CF, Kuritzkes DR, Quercia R, Patel P, et al. Exploring predictors of HIV-1 virologic failure to long-acting cabotegravir and rilpivirine: a multivariable analysis. AIDS. 2021;35(9):1333-42.  https://doi.org/10.1097/QAD.0000000000002883  PMID: 33730748 
  11. Rizzardini G, Overton ET, Orkin C, Swindells S, Arasteh K, Górgolas Hernández-Mora M, et al. Long-Acting Injectable cabotegravir + rilpivirine for HIV maintenance therapy: week 48 pooled analysis of phase 3 ATLAS and FLAIR trials. J Acquir Immune Defic Syndr. 2020;85(4):498-506.  https://doi.org/10.1097/QAI.0000000000002466  PMID: 33136751 
  12. Eron J J, Little SR, Crofoot G, Cook P, Ruane P, Jayaweera D, et al. Lenacapavir with bNAbs GS-5423 and GS-2872 dosed every 6 months in people with HIV. Conference on Retroviruses and Opportunistic Infections; 20-23 February 2023, Seattle, United States. Oral abstract 193. Available from: https://www.natap.org/2023/CROI/croi_36.htm
  13. Carlander C, Wagner P, Yilmaz A, Sparén P, Svedhem V. Employment by HIV status, mode of HIV transmission and migrant status: a nation-wide population-based study. AIDS. 2021;35(1):115-23.  https://doi.org/10.1097/QAD.0000000000002724  PMID: 33048876 
  14. R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2021. Available from: https://www.R-project.org
  15. Struck D, Lawyer G, Ternes AM, Schmit JC, Bercoff DP. COMET: adaptive context-based modeling for ultrafast HIV-1 subtype identification. Nucleic Acids Res. 2014;42(18):e144.  https://doi.org/10.1093/nar/gku739  PMID: 25120265 
  16. Rhee SY, Gonzales MJ, Kantor R, Betts BJ, Ravela J, Shafer RW. Human immunodeficiency virus reverse transcriptase and protease sequence database. Nucleic Acids Res. 2003;31(1):298-303.  https://doi.org/10.1093/nar/gkg100  PMID: 12520007 
  17. Hadfield J, Megill C, Bell SM, Huddleston J, Potter B, Callender C, et al. Nextstrain: real-time tracking of pathogen evolution. Bioinformatics. 2018;34(23):4121-3.  https://doi.org/10.1093/bioinformatics/bty407  PMID: 29790939 
  18. Skar H, Axelsson M, Berggren I, Thalme A, Gyllensten K, Liitsola K, et al. Dynamics of two separate but linked HIV-1 CRF01_AE outbreaks among injection drug users in Stockholm, Sweden, and Helsinki, Finland. J Virol. 2011;85(1):510-8.  https://doi.org/10.1128/JVI.01413-10  PMID: 20962100 
  19. Kuznetsova A, Lebedev A, Gromov K, Kazennova E, Zazzi M, Incardona F, et al. Pre-existing singleton E138A mutations in the reverse transcriptase gene do not affect the efficacy of first-line antiretroviral therapy regimens using rilpivirine in human immunodeficiency virus-infected patients. Clin Case Rep. 2022;10(2):e05373.  https://doi.org/10.1002/ccr3.5373  PMID: 35140966 
  20. Neogi U, Siddik AB, Kalaghatgi P, Gisslén M, Bratt G, Marrone G, et al. Recent increased identification and transmission of HIV-1 unique recombinant forms in Sweden. Sci Rep. 2017;7(1):6371.  https://doi.org/10.1038/s41598-017-06860-2  PMID: 28744024 
  21. Andersson E, Ambikan A, Brännström J, Aralaguppe SG, Yilmaz A, Albert J, et al. High-throughput sequencing reveals a high prevalence of pretreatment HIV-1 drug resistance in Sweden. AIDS. 2021;35(2):227-34.  https://doi.org/10.1097/QAD.0000000000002740  PMID: 33394670 
  22. Feiterna-Sperling C, Bethke H, Hofmann J, Krüger R. Refugees from Ukraine: children and adolescents with HIV in Germany. Lancet HIV. 2023;10(2):e81-2.  https://doi.org/10.1016/S2352-3018(22)00398-8  PMID: 36642086 
  23. Parczewski M, Jabłonowska E, Wójcik-Cichy K, Zhyvytsia D, Witak-Jędra M, Leszczyszyn-Pynka M, et al. Clinical perspective on human immunodeficiency virus care of Ukrainian war refugees in Poland. Clin Infect Dis. 2023;76(10):1708-15.  https://doi.org/10.1093/cid/ciad116  PMID: 36888680 
  24. Brännström J, Svedhem Johansson V, Marrone G, Wendahl S, Yilmaz A, Blaxhult A, et al. Deficiencies in the health care system contribute to a high rate of late HIV diagnosis in Sweden. HIV Med. 2016;17(6):425-35.  https://doi.org/10.1111/hiv.12321  PMID: 26559921 
  25. Public Health Center of the Ministry of Health of Ukraine. HIV Infection in Ukraine. Newsletter No. 51. 1. Kyiv: Public Health Center; 2020. Available from: https://phc.org.ua/sites/default/files/users/user90/HIV_in_UA_51_2020_EN.pdf
/content/10.2807/1560-7917.ES.2023.28.48.2300224
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error