Caution is needed in interpreting HIV transmission chains by ultradeep sequencing.

OBJECTIVES: Molecular epidemiology is applied to various aspects of HIV transmission analyses. With ultradeep sequencing (UDS), in-depth characterization of transmission episodes involving minority variants is permitted. We explored HIV-1 epidemiological linkage and evaluated characteristics of transmission dynamics and transmitted drug resistance (TDR) detection through the added value of UDS. DESIGN: HIV pol gene fragments were sequenced by UDS and Sanger sequencing on samples of 70 HIV-1-infected, treatment-naive recently diagnosed MSM. METHODS: Pairwise genetic distances and maximum likelihood phylogenies were computed. Transmission events were identified as clades with branch support at least 70% and intraclade genetic difference less than 4.5%. TDR mutations were recognized from the TDR consensus list. Transmission directionality, directness and inoculum size were inferred from tree topologies. RESULTS: Both datasets concurred in the identification of seven transmission pairs and one cluster of three patients. With UDS, direction of transmission was inferred in four out of eight chains. Evidence for multiple founder viruses was found in two out of eight chains. No transmission of minority-resistant variants was evidenced. TDR mutations prevalence in protease and reverse transcriptase fragments was 4.3% with Sanger sequencing and 18.6% with UDS. CONCLUSION: Although Sanger sequencing and UDS identified the same transmission chains, UDS provided additional information on founder viruses, direction of transmission and levels of TDR. Nevertheless, topology of clusters was not always consistent across gene fragments, calling for a cautious interpretation of the data. Moreover, unobserved intermediary links cannot be excluded. Phylogenetic analysis use as a forensic technique for HIV transmission investigations is risky

High clustering of acute HCV infections and high rate of associated STIs among Parisian HIV-positive male patients.

BACKGROUND: Increasing incidence of hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-positive men having sex with men (MSM) has been described in recent years. Phylogenetic analyses of acute HCV infections were undertaken to characterize the dynamics during the epidemic in Paris, and associated sexually transmitted infections (STIs) were evaluated. METHODS: Sanger sequencing of polymerase gene was performed. Maximum likelihood phylogenies were reconstructed using FastTree 2.1 under a GTR+CAT model. Transmission chains were defined as clades with a branch probability ≥0.80 and intraclade genetic distances <0.02 nucleotide substitutions per sites. STIs detected ≤1 month before HCV diagnosis were considered. RESULTS: Among the 85 studied patients, at least 81.2% were MSM. Respectively, 47.6%, 39.0%, 11.0% and 2.4% were infected with genotypes 1a, 4d, 3a and 2k. At least 91.8% were co-infected with HIV. HCV re-infection was evidenced for 24.7% of patients and STIs for 20.0% of patients. Twenty-two transmission chains were identified, including 52 acute hepatitis C (11 pairs and 11 clusters from three to seven patients). CONCLUSIONS: These results revealed strong clustering of acute HCV infections. Thus, rapid treatment of both chronic and acute infections is needed among this population to decrease the prevalence of HCV, in combination with preventive behavioural interventions

Study of minority resistant variants to antiretroviral : impact on virologic response to treatment

Les mutations de résistance pour une molécule sont produites avant que la molécule en question ne soit utilisée, et c’est sous « pression de sélection » que la souche résistante va être sélectionnée. Des données récentes montrent que des variants résistants minoritaires (VRMs) peuvent être une source d’échec virologique. Les nouvelles techniques de séquençage sont bien plus sensibles que les techniques classiques de séquençage et permettent la détection des VRMs. Afin d’évaluer l’intérêt de l’utilisation de ces techniques, nous avons étudié les prélèvements de patients en situation d’échec virologique après traitement par deux combinaisons antirétrovirales très utilisées (tenofovir/emtricitabine/efarirenz et tenofovir/emtricitabine/rilpivirine). De nombreux variants de résistance supplémentaires ont été détectés, touchant principalement la classe des Inhibiteurs Nucléosidiques de la Transcriptase Inverse (INTIs), avec un impact potentiel sur le choix du traitement de relais. Nous avons également étudié la prévalence des mutations de résistance transmise sur le gène de la protéase et de la transcriptase inverse chez des patients naïfs chroniquement infectés, chez deux groupes de transmission : des patients hommes ayant des rapports avec d’autres hommes (HSH), et des patients hétérosexuels. Nous avons retrouvé une prévalence plus élevée de mutations touchant les INTIs dans le groupe des patients hétérosexuels. Parmi les patients HSH, ceux infectés par un virus de sous-type B étaient plus fréquemment infectés par un virus résistant. Cette thèse met en avant la puissance des ces techniques, dont les conditions d'utilisation ne sont pas encore complètement définies.Resistance mutations for a given molecule are produced before the molecule is used, and it is under "selection pressure" that the resistant strain will be selected. Recent data show that minority resistant variants (MRV) can be a source of virologic failure. New sequencing techniques are much more sensitive than conventional sequencing techniques and allow MRV detection. To assess the value of these new techniques, we studied samples from patients experiencing virologic failure after treatment with two antiretroviral combinations widely used (tenofovir/emtricitabine/efarirenz et tenofovir/emtricitabine/rilpivirine). Many additional resistance variants affecting the class of nucleoside reverse transcriptase inhibitors (NRTIs) were detected, with a potential impact on the choice of the subsequent regimen. We also studied the prevalence of transmitted resistance mutations in the protease and reverse transcriptase genes among naive patients chronically infected, among two groups of transmission: patients of men who have sex with men (MSM) and heterosexual patients. We found a higher prevalence of NRTI mutations among the heterosexual group. Among MSM patients, those infected with subtype B viruses were more frequently infected with a resistant virus. This thesis highlights the power of these techniques, the conditions of use are not yet fully defined

Etude des variants résistants minoritaires aux antirétroviraux : impact sur la réponse virologique au traitement

Resistance mutations for a given molecule are produced before the molecule is used, and it is under "selection pressure" that the resistant strain will be selected. Recent data show that minority resistant variants (MRV) can be a source of virologic failure. New sequencing techniques are much more sensitive than conventional sequencing techniques and allow MRV detection. To assess the value of these new techniques, we studied samples from patients experiencing virologic failure after treatment with two antiretroviral combinations widely used (tenofovir/emtricitabine/efarirenz et tenofovir/emtricitabine/rilpivirine). Many additional resistance variants affecting the class of nucleoside reverse transcriptase inhibitors (NRTIs) were detected, with a potential impact on the choice of the subsequent regimen. We also studied the prevalence of transmitted resistance mutations in the protease and reverse transcriptase genes among naive patients chronically infected, among two groups of transmission: patients of men who have sex with men (MSM) and heterosexual patients. We found a higher prevalence of NRTI mutations among the heterosexual group. Among MSM patients, those infected with subtype B viruses were more frequently infected with a resistant virus. This thesis highlights the power of these techniques, the conditions of use are not yet fully defined.Les mutations de résistance pour une molécule sont produites avant que la molécule en question ne soit utilisée, et c’est sous « pression de sélection » que la souche résistante va être sélectionnée. Des données récentes montrent que des variants résistants minoritaires (VRMs) peuvent être une source d’échec virologique. Les nouvelles techniques de séquençage sont bien plus sensibles que les techniques classiques de séquençage et permettent la détection des VRMs. Afin d’évaluer l’intérêt de l’utilisation de ces techniques, nous avons étudié les prélèvements de patients en situation d’échec virologique après traitement par deux combinaisons antirétrovirales très utilisées (tenofovir/emtricitabine/efarirenz et tenofovir/emtricitabine/rilpivirine). De nombreux variants de résistance supplémentaires ont été détectés, touchant principalement la classe des Inhibiteurs Nucléosidiques de la Transcriptase Inverse (INTIs), avec un impact potentiel sur le choix du traitement de relais. Nous avons également étudié la prévalence des mutations de résistance transmise sur le gène de la protéase et de la transcriptase inverse chez des patients naïfs chroniquement infectés, chez deux groupes de transmission : des patients hommes ayant des rapports avec d’autres hommes (HSH), et des patients hétérosexuels. Nous avons retrouvé une prévalence plus élevée de mutations touchant les INTIs dans le groupe des patients hétérosexuels. Parmi les patients HSH, ceux infectés par un virus de sous-type B étaient plus fréquemment infectés par un virus résistant. Cette thèse met en avant la puissance des ces techniques, dont les conditions d'utilisation ne sont pas encore complètement définies

Les VIH-1 hyper-résistants (études clonales et impacts thérapeutiques des souches du VIH-1 résistantes aux nouveaux antirétroviraux)

PARIS-BIUP (751062107) / SudocSudocFranceF

Epidemiology and Characteristics of SARS-CoV-2 Variants of Concern: The Impacts of the Spike Mutations

SARS-CoV-2 expresses on its surface the Spike protein responsible for binding with the ACE2 receptor and which carries the majority of immunodominant epitopes. Mutations mainly affect this protein and can modify characteristics of the virus, giving each variant a unique profile concerning its transmissibility, virulence, and immune escape. The first lineage selected is the B.1 lineage characterized by the D614G substitution and from which all SARS-CoV-2 variants of concern have emerged. The first three variants of concern Alpha, Beta, and Gamma spread in early 2021: all shared the N501Y substitution. These variants were replaced by the Delta variant in summer 2021, carrying unique mutations like the L452R substitution and associated with higher virulence. It was in turn quickly replaced by the Omicron variant at the end of 2021, which has predominated since then, characterized by its large number of mutations. The successive appearance of variants of concern showed a dynamic evolution of SARS-CoV-2 through the selection and accumulation of mutations. This has not only allowed progressive improvement of the transmissibility of SARS-CoV-2, but has also participated in a better immune escape of the virus. This review brings together acquired knowledge about SARS-CoV-2 variants of concern and the impacts of the Spike mutations

Prolonged replication of BA.1 and BA.2 Omicron lineages compared to Delta variant in nasopharyngeal samples from COVID-19 patients

International audienceObjectives: We aimed to characterize and compare the viral loads (VL) of the Omicron BA.1 and BA.2 lineages and the Delta variant in nasopharyngeal samples from newly diagnosed COVID-19 patients and their kinetics over time.Patients and methods: The kinetics of the VL were measured on the CT data from 215 SARS-CoV-2 positive patients who presented at least two positive PCRs a day apart and were screened for SARS-CoV-2 viral lineages.Results: We observed no significant difference in median CT value during the first diagnostic test between the Delta variant and the two Omicron lineages. However, the kinetics of CT decreases for the BA.1 and BA.2 lineage were significantly lengthier in time than the kinetics for the Delta variant. The BA.2 lineage presented lower median CT value (-2 CT) (inversely proportional to the VL) than the BA.1 lineage.Conclusions: BA.2 Omicron lineage presented higher VL than BA.1 Omicron lineage at diagnostic. Omicron BA.1 and BA.2 lineages have more prolonged replication than the Delta variant

Chronic hepatitis E in HIV/HBV coinfected patient: lack of power of sofosbuvir-ribavirin

International audienceno abstrac