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AIDS Res Hum Retroviruses. 2018 Oct;34(10):879-888. doi: 10.1089/AID.2018.0039. Epub 2018 Aug 23.

HIV-1 Transmission Clustering and Phylodynamics Highlight the Important Role of Young Men Who Have Sex with Men.

Author information

1
1 Division of Infectious Diseases, University of North Carolina , Chapel Hill, North Carolina.
2
2 Department of Infectious Disease Epidemiology and Centre for Outbreak Analysis and Modeling, Imperial College , London, United Kingdom .
3
3 Department of Veterinary Medicine, University of Cambridge , Cambridge, United Kingdom .
4
4 Department of Pathology and Laboratory Medicine, Western University , London, Canada .
5
5 Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee.
6
6 Department of Epidemiology of Microbial Diseases, Yale University School of Public Health , New Haven, Connecticut.

Abstract

More persons living with HIV reside in the Southern United States than in any other region, yet little is known about HIV molecular epidemiology in the South. We used cluster and phylodynamic analyses to evaluate HIV transmission patterns in middle Tennessee. We performed cross-sectional analyses of HIV-1 pol sequences and clinical data collected from 2001 to 2015 among persons attending the Vanderbilt Comprehensive Care Clinic. Transmission clusters were identified using maximum likelihood phylogenetics and patristic distance differences. Demographic, risk behavior, and clinical factors were assessed evaluating "active" clusters (clusters including sequences sampled 2011-2015) and associations estimated with logistic regression. Transmission risk ratios for men who have sex with men (MSM) were estimated with phylodynamic models. Among 2915 persons (96% subtype-B sequences), 963 (33%) were members of 292 clusters (distance ≤1.5%, size range 2-39). Most clusters (62%, n = 690 persons) were active, either being newly identified (n = 80) or showing expansion on existing clusters (n = 101). Correlates of active clustering among persons with sequences collected during 2011-2015 included MSM risk and ≤30 years of age. Active clusters were significantly more concentrated in MSM and younger persons than historical clusters. Young MSM (YMSM) (≤26.4 years) had high estimated transmission risk [risk ratio = 4.04 (2.85-5.65) relative to older MSM] and were much more likely to transmit to YMSM. In this Tennessee cohort, transmission clusters over time were more concentrated by MSM and younger age, with high transmission risk among and between YMSM, highlighting the importance of interventions among this group. Detecting active clusters could help direct interventions to disrupt ongoing transmission chains.

KEYWORDS:

HIV-1; Southeastern United States; men who have sex with men; molecular epidemiology; phylogeny; transmission

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