{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T22:11:36Z","timestamp":1785363096284,"version":"3.55.0"},"reference-count":32,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:00:00Z","timestamp":1768435200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Investments and European Projects","award":["MySMIS 324809"],"award-info":[{"award-number":["MySMIS 324809"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>The HIV epidemic in Romania started in the late eighties with a large cohort of children nosocomially infected with subtype F1 strains, in parallel with sexual transmission. The purpose of the present study was to investigate the transmitted drug resistance (TDR), subtype distribution, and transmission clusters among persons diagnosed with HIV between 2019 and 2022 in Romania. The prototype of a person recently diagnosed with HIV in Romania is male, 20\u201350 years old, a late presenter, infected with F1, B, or A subtype. The rate of TDR varied over time, from 5% in 2019 to 15% in 2022. TDR affected mainly the first generation of NNRTIs and the PI class. The rate of late presentation was almost 60%, with 35% of persons qualifying as very late presenters. Subtype F1 is still preponderant in Romania, whereas other subtypes (B, A) and recombinants account for a quarter of HIV-1 new cases. Several transmission networks were identified in the study population, two of them associated with TDR in subtypes F1 and A1. The largest cluster consisted of 26 sequences, originating from Western Romania and introduced around 2007. Molecular clock analysis indicated different origin time points for different clusters, with the most recent in subtypes A1 and B, and the oldest in subtype F1. In conclusion, the HIV-1 epidemic in Romania is currently driven by sexual transmission, with MSM contribution continuously rising in recent years; there are also increases in TDR and the circulation of HIV-1 strains other than F1 (subtype B, A, recombinants).<\/jats:p>","DOI":"10.3390\/v18010118","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T14:35:38Z","timestamp":1768487738000},"page":"118","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluating HIV-1 Transmitted Drug Resistance and Clustering in Newly Diagnosed Patients in Romania (2019\u20132022)"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9956-951X","authenticated-orcid":false,"given":"Leontina","family":"Banica","sequence":"first","affiliation":[{"name":"University of Medicine and Pharmacy \u201cCarol Davila\u201d, 020021 Bucharest, Romania"},{"name":"National Institute for Infectious Diseases \u201cProf. Dr. Matei Bal\u0219\u201d, 021105 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8616-6559","authenticated-orcid":false,"given":"Robert","family":"Hohan","sequence":"additional","affiliation":[{"name":"National Institute for Infectious Diseases \u201cProf. Dr. Matei Bal\u0219\u201d, 021105 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ionelia","family":"Nicolae","sequence":"additional","affiliation":[{"name":"National Institute for Infectious Diseases \u201cProf. Dr. Matei Bal\u0219\u201d, 021105 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca","family":"Patrascu","sequence":"additional","affiliation":[{"name":"University of Medicine and Pharmacy \u201cCarol Davila\u201d, 020021 Bucharest, Romania"},{"name":"National Institute for Infectious Diseases \u201cProf. Dr. Matei Bal\u0219\u201d, 021105 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corina","family":"Casangiu","sequence":"additional","affiliation":[{"name":"National Institute for Infectious Diseases \u201cProf. Dr. Matei Bal\u0219\u201d, 021105 Bucharest, Romania"},{"name":"The Research Institute of the University of Bucharest, 050663 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6707-3720","authenticated-orcid":false,"given":"Simona","family":"Paraschiv","sequence":"additional","affiliation":[{"name":"University of Medicine and Pharmacy \u201cCarol Davila\u201d, 020021 Bucharest, Romania"},{"name":"National Institute for Infectious Diseases \u201cProf. Dr. Matei Bal\u0219\u201d, 021105 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Voichita Elena","family":"Lazureanu","sequence":"additional","affiliation":[{"name":"University of Medicine and Pharmacy \u201cDr. Victor Babe\u0219\u201d, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerica Bica","family":"Profir","sequence":"additional","affiliation":[{"name":"\u201cDr. Victor Babe\u0219\u201d Pneumophtysiology Infectious Diseases Hospital, 300310 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6167-7152","authenticated-orcid":false,"given":"Dimitrios","family":"Paraskevis","sequence":"additional","affiliation":[{"name":"Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Otelea","sequence":"additional","affiliation":[{"name":"National Institute for Infectious Diseases \u201cProf. Dr. Matei Bal\u0219\u201d, 021105 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/S0140-6736(23)00877-2","article-title":"The risk of sexual transmission of HIV in individuals with low-level HIV viraemia: A systematic review","volume":"402","author":"Broyles","year":"2023","journal-title":"Lancet"},{"key":"ref_2","unstructured":"World Health Organization (2025, September 25). Global HIV Programme (HIV Data and Statistics). Available online: https:\/\/www.who.int\/teams\/global-hiv-hepatitis-and-stis-programmes\/hiv\/strategic-information\/hiv-data-and-statistics."},{"key":"ref_3","unstructured":"(2025, September 25). Compartimentul Pentru Monitorizarea si Evaluarea Infectiei HIV\/SIDA in Romania. Evolutia HIV in Romania 30 Iunie 2025. Available online: https:\/\/www.cnlas.ro\/images\/doc\/2025\/evolutia-hiv-romania-iunie-2025.pptx."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1089\/aid.1997.13.363","article-title":"HIV type 1 subtype F sequences in Romanian children and adults","volume":"13","author":"Apetrei","year":"1997","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Paraschiv, S., Banica, L., Nicolae, I., Niculescu, I., Abagiu, A., Jipa, R., Pineda-Pe\u00f1a, A.-C., Pingarilho, M., Neaga, E., and Theys, K. (2017). Epidemic dispersion of HIV and HCV in a population of co-infected Romanian injecting drug users. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0185866"},{"key":"ref_6","unstructured":"(2025, September 25). Compartimentul Pentru Monitorizarea si Evaluarea Infectiei HIV\/SIDA in Romania. Available online: https:\/\/www.cnlas.ro."},{"key":"ref_7","unstructured":"(2025, September 25). European AIDS Clinical Society\u2014Guidelines Version 12.0. Available online: https:\/\/www.eacsociety.org\/media\/guidelines-12.0.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1186\/s13063-024-08313-4","article-title":"Prepare Romania: Study protocol for a randomized controlled trial of an intervention to promote pre-exposure prophylaxis adherence and persistence among gay, bisexual, and other men who have sex with men","volume":"25","author":"Filimon","year":"2024","journal-title":"Trials"},{"key":"ref_9","unstructured":"(2025, September 25). Compartimentul Pentru Monitorizarea si Evaluarea Infectiei HIV\/SIDA in Romania. Evolutia HIV in Romania 31 Decembrie 2024. Available online: https:\/\/cnlas.ro\/images\/doc\/2025\/ROMANIA%20LA%2031%20DECEMBRIE%20-2024%20-%20site.pdf."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Hohan, R., Paraschiv, S., Nicolae, I., and O\u021belea, D. (2024). Estimating the current routes of transmission in HIV-1 F1 subtype infected persons in Romania: Differences between self-reporting and phylogenetic data. Pathogens, 13.","DOI":"10.3390\/pathogens13110960"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Bennett, D.E., Camacho, R.J., Otelea, D., Kuritzkes, D.R., Fleury, H., Kiuchi, M., Heneine, W., Kantor, R., Jordan, M.R., and Schapiro, J.M. (2009). Drug resistance mutations for surveillance of transmitted HIV-1 drug-resistance: 2009 update. PLoS ONE, 4.","DOI":"10.1371\/journal.pone.0004724"},{"key":"ref_12","unstructured":"HIV Sequence Database (2025, September 25). Hypermut 3 Analysis & Detection of APOBEC-induced Hypermutation, Available online: https:\/\/www.hiv.lanl.gov\/content\/sequence\/HYPERMUT\/hypermutv3.html."},{"key":"ref_13","unstructured":"Genome Detective (2025, September 25). REGA HIV Subtyping Tool. Available online: https:\/\/www.genomedetective.com\/app\/typingtool\/hiv."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e144","DOI":"10.1093\/nar\/gku739","article-title":"COMET: Adaptive context-based modeling for ultrafast HIV-1 subtype identification","volume":"42","author":"Struck","year":"2014","journal-title":"Nucleic Acids Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"ugae003","DOI":"10.1093\/narmme\/ugae003","article-title":"Geno2pheno: Recombination detection for HIV-1 and HEV subtypes","volume":"1","author":"Pirkl","year":"2024","journal-title":"NAR Mol. Med."},{"key":"ref_16","unstructured":"(2025, September 25). GenBank, Available online: https:\/\/www.ncbi.nlm.nih.gov\/genbank\/."},{"key":"ref_17","unstructured":"(2025, September 25). HIV Sequence Database, Available online: https:\/\/www.hiv.lanl.gov\/content\/sequence\/HIV\/mainpage.html."},{"key":"ref_18","first-page":"657","article-title":"Chemsex: Emerging threats facing the MSM experience\u2014A cross-sectional study","volume":"37","author":"Ly","year":"2025","journal-title":"Ann. Di Igiene"},{"key":"ref_19","first-page":"101243","article-title":"Control of HIV across the WHO European region: Progress and remaining challenges","volume":"52","author":"Parczewski","year":"2025","journal-title":"Lancet Reg. Health\u2014Eur."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1007\/s40265-019-01108-x","article-title":"Drug resistance during HIV pre-exposure prophylaxis","volume":"79","author":"Gibas","year":"2019","journal-title":"Drugs"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e70011","DOI":"10.1002\/jia2.70011","article-title":"A cross-sectional study evaluating the frequency of HIV drug resistance mutations among individuals diagnosed with HIV-1 in tenofovir disoproxil fumarate-based pre-exposure prophylaxis rollout programmes in Kenya, Zimbabwe, Eswatini and South Africa","volume":"28","author":"Parikh","year":"2025","journal-title":"J. Int. AIDS Soc."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Planini\u0107, A., Begovac, J., Roki\u0107, F., \u0160imi\u010di\u0107, P., Oroz, M., Jakovac, K., Vugrek, O., and Zidovec-Lepej, S. (2023). Characterization of human immunodeficiency virus-1 transmission clusters and transmitted drug-resistant mutations in Croatia from 2019 to 2022. Viruses, 15.","DOI":"10.3390\/v15122408"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1038\/s41591-023-02763-0","article-title":"HIV drug resistance to integrase inhibitors in low- and middle-income countries","volume":"30","author":"Fokam","year":"2024","journal-title":"Nat. Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Partsuneva, A., Gancheva, A., Dimitrova, R., Grigorova, L., Kostadinova, A., Nikolova, M., Emilova, R., Yancheva, N., Grozdeva, R., and Alexiev, I. (2025). Distinct molecular epidemiology, transmission patterns, and resistance mutations of HIV-1 subtypes A1, A6, and A7 in Bulgaria. Microorganisms, 13.","DOI":"10.3390\/microorganisms13051108"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s10903-023-01559-1","article-title":"Changes in primary HIV-1 drug resistance due to war migration from eastern Europe","volume":"26","author":"Lembas","year":"2024","journal-title":"J. Immigr. Minor. Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1097\/00002030-199809000-00016","article-title":"HIV-1 diversity in Romania","volume":"12","author":"Apetrei","year":"1998","journal-title":"AIDS"},{"key":"ref_27","first-page":"28","article-title":"HIV 1 molecular epidemiology in the Balkans: A melting pot for high genetic diversity","volume":"14","author":"Stanojevic","year":"2012","journal-title":"AIDS Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"100912","DOI":"10.1016\/S2666-5247(24)00151-4","article-title":"Global and regional genetic diversity of HIV-1 in 2010\u201321: Systematic review and analysis of prevalence","volume":"5","author":"Nair","year":"2024","journal-title":"Lancet Microbe"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e29482","DOI":"10.1002\/jmv.29482","article-title":"Phylodynamic evolution of HIV-1 A6 sub-subtype epidemics in Poland","volume":"96","author":"Serwin","year":"2024","journal-title":"J. Med. Virol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"12734","DOI":"10.1038\/s41598-021-92210-2","article-title":"Transmitted HIV drug resistance and subtype patterns among blood donors in Poland","volume":"11","author":"Parczewski","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1016\/j.meegid.2012.03.003","article-title":"Molecular typing of the recently expanding subtype B HIV-1 epidemic in Romania: Evidence for local spread among MSMs in Bucharest area","volume":"12","author":"Paraschiv","year":"2012","journal-title":"Infect. Genet. Evol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1089\/aid.2014.0189","article-title":"Recent HIV-1 Outbreak Among Intravenous Drug Users in Romania: Evidence for Cocirculation of CRF14_BG and Subtype F1 Strains","volume":"31","author":"Niculescu","year":"2015","journal-title":"AIDS Res. Hum. Retroviruses"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/1\/118\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T14:40:56Z","timestamp":1768488056000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/1\/118"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,15]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["v18010118"],"URL":"https:\/\/doi.org\/10.3390\/v18010118","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,15]]}}}