@article {11018,
	title = {Spatiotemporal characteristics of the HIV-1 CRF02_AG/CRF63_02A1 epidemic in Russia and central Asia.},
	journal = {AIDS Res Hum Retroviruses},
	year = {2018},
	month = {2018 Feb 17},
	abstract = {BACKGROUND: Eastern European countries including Russia, Ukraine and other former Soviet Union (FSU) countries have experienced an HIV epidemic spreading mostly among people who inject drugs (PWID). We aimed to investigate the origin and the dispersal patterns of HIV-1 CRF02_AG in Russia and other FSU countries.

METHODS: We studied 136 CRF02_AG sequences originating from Russia, and FSU countries along with a globally sampled dataset of 3,580 CRF02_AG sequences. Maximum-likelihood phylogeny reconstruction with bootstrap evaluation was conducted in RAxML. Bayesian phylogeographic analysis was performed in BEAST v1.8 using the discrete trait model.

RESULTS: We found that all CRF02_AG sequences from Russia and other FSU countries formed a single monophyletic cluster within CRF02_AG radiation. The Russian/FSU clade was classified as CRF63_02A1. Sequences from the FSU countries clustered further within distinct subclades (two from Russia, three from Uzbekistan and one Kazakhstan) according to the geographic origin of sampling. Molecular clock analysis revealed that the tMRCA of the CRF63_02A1 epidemic was in 1996 (95\%HPD: 1992-1999), while for the two Russian subclades, tMRCA was estimated in 2003 (95\%HPD: 2001-2004) and in 2007 (95\%HPD: 2005-2008). Phylogeographic analysis suggested that the potential origin of the epidemic was in Uzbekistan. Early dispersal of CRF63_02A1 occurred in Kazakhstan and Uzbekistan and thereafter the epidemic spread to Russia. Notably, spillover transmissions to Russia kept occurring in both countries.

DISCUSSION: Previous studies have shown that Russia and Ukraine have provided the source for the PWID-driven, HIV-1 subtype-A epidemic, spreading across the FSU countries (AFSU). In great contrast, CRF63_02A1 established an epidemic in central Asia (Uzbekistan and Kazakhstan), from where it subsequently disseminated to Russia. Our study suggests that cross-border transmissions among PWID occur bi-directionally between Russian and other FSU populations. These results are of public health importance and suggest that prevention actions have to be reinforced in this area to assist the management of high-risk practices.},
	issn = {1931-8405},
	doi = {10.1089/AID.2017.0233},
	author = {Kostaki, Evangelia-Georgia and Karamitros, Timokratis and Bobkova, Marina and Oikonomopoulou, Martha and Magiorkinis, Gkikas and Garcia, Federico and Hatzakis, Angelos and Paraskevis, Dimitrios}
}
