A major proportion of the
HIV infections worldwide is caused by group M of HIV-1 genotype and to date approximately nine subtypes and 50 circulating recombinant forms (CRFs) in the group M have been recognized. Recombinants between different HIV-1 group M subtypes are designated as CRF. The objective of this study was to present, for the first time, a HIV-1 positive case infected with CRF08_BC subtype in Turkey. In beginning of 2011, a sailor, 48-year-old male was admitted to hospital with
fever, loss of appetite,
weight loss, 15 days lasting
diarrhea and bilateral axillary
lymphadenitis. The laboratory tests yielded
anti-HIV positivity, HIV-
RNA positivity (129.000 copies/ml) and CD4+ T-cell count of 11 cells/mm3 (1.3%). He had a history of multiple unprotected sexual contacts during his journey to various far-east countries. His clinical level was defined as C3 according to CDC classification. Since drug resistance analysis done before the initiation of antiretroviral
therapy indicated no antiretroviral resistance,
tenofovir/emtricitabin +
efavirenz therapy was initiated. In the 16th months of the
therapy, decreasing CD4+ T-cell count, HIV-
RNA positivity and worsening of clinical condition (development of herpes lesions and
pulmonary tuberculosis) suggested an unresponsiveness to
therapy,
efavirenz was replaced with
tenofovir/emtricitabin +
lopinavir/
ritonavir. The patient was also treated with quadruple anti-tuberculous treatment based on the clinical and radiological findings of
pulmonary tuberculosis. The
protease domain (
codon 1-99, 330 bp) of pol gene of HIV-1 strain obtained from pretreatment plasma sample, had been amplified by nested PCR and sequenced. This HIV-1 strain was then subtyped as CRF08_BC after phylogenetic analysis with neighbor-joining method (GenBank accession number: JX536763.1). In the world, HIV-1 CRF08_BC is substantially prevalent in southwestern China among injecting drug users. Our data suggested that the CRF08_BC subtype is also present in Turkey. Molecular epidemiologic studies are important tools for tracking transmission patterns, spread and for the control of the
HIV infections in a given area. Therefore, HIV molecular research should be expanded in HIV-1 infected Turkish patients. The determination of subtype CRF08_BC of HIV-1 in Turkey may be contribute to global HIV surveillance systems.