P3.190 Epidemiology of HIV Infection Before and After Rising the Iron Curtain: The Hungarian Experience

Abstract

Background: In the beginning of 21st Century Hungary has a good epidemiological situation concerning HIV infections and AIDS which was the result of the strict but consistent introduction of nationwide HIV screening in 1985, and the good cooperation of clinicians, researchers and government officials. Methods: HIV subtypes and genetic resistance (allele frequencies of CCR5-DELTA32, CCR2-64I and SDF1-3'A) were determined by molecular virological methods, antiretroviral drug resistance in primary HIV infection and transmission of HIV CRFs by illegal migrants were analysed by genotyping (Truegene HIV-1 Genotyping System/Siemens/). New approach in inhibiting HIV infection on cellular level by modifying SH-groups of CD4 and HIV gp120 env by novel thyolated nucleosides were developed using viral pseudotypes. Results: In the last 28 years MSM is still the highest risk group, while HIV infection is low in i.v. drug users. In the early years HIV B subtypes were determined as major circulating variants. CCR5-DELTA32 was found in 12% of general population and 15% in ethnic gypsy minority. Genotyping revealed, that approx. 15% of primary HIV infections are transmitted by drug resistant mutants mainly in MSMs. After 2004, when Hungary joined to the European Union illegal migration increased, besides the prostitutes mainly from SE Asia and Africa, resulting in the appearance of new HIV subtypes and African CRFs, such as CRF02-AG (28.5%), CRF06-cpx (17.8%) and CRF11-cpx(3.6%). Novel entry inhibitor UD was effective in vitro in 5 uM. Discussion Transmission of drug-resistant HIV during primary infection, penetration of African CRFs raise serious clinical and public health consequences. To maintain the recent favourable epidemiological situation screening programmes should be continued, HIV genotyping at the time of diagnosis should be the standard of care, and introduction of novel compounds, such as entry inhibitors in the treatment are necessary.