[The first detected HIV-1 recombinant strain in Turkey: CRF08_BC]

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.