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Clin Infect Dis. 2018 Nov 26. doi: 10.1093/cid/ciy1006. [Epub ahead of print]

HIV-1 transmission among persons with acute HIV-1 infection in Malawi: demographic, behavioral and phylogenetic relationships.

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Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Lighthouse Trust, Lilongwe, Malawi.
UNC Project, Lilongwe, Malawi.
Department of Epidemiology, Ohio State University, Columbus, OH.



Understanding of sexual networks involving acute HIV-1 infections (AHI) may lead to prevention opportunities to mitigate high rates of onward transmission. We evaluated HIV-1 phylogenetic and behavioral characteristics among persons with AHI and their referred partners.


Between 2012 and 2014, 46 persons with AHI in Malawi participated in a combined behavioral and biomedical intervention. Participants referred sexual partners for HIV-1 testing by passive referral. Demographics and sexual behaviors were collected through interviews. We used maximum-likelihood phylogenetic analyses of HIV-1 pol sequences to assess genetic relationships.


Among 45 AHI participants with HIV-1 sequences, none was phylogenetically-linked with another AHI index. Nineteen (42%) AHI participants referred a single partner who returned for testing. Most referred partners (n=17) were or became HIV-infected with 15 (88%) presenting with established infection. Fourteen index-partner pairs had sequences available; 13 (93%) pairs were phylogenetically-linked dyads. The AHI index was female in 7/13 (54%) dyads. Age-disparate relationships among dyads were common (≥5-year age difference in 67% of dyads), including 3/6 dyads involving a male AHI index and a younger woman. Index participants with a referred partner were more likely to report no casual partners and to be living with their current partner than participants not in observed dyads.


Passive partner referral successfully identified partners with genetically similar HIV-infection - the likely source of infection - but only 40% of index cases referred partners who presented for HIV-1 testing. Future work evaluating assisted partner notification may help reach susceptible partners or more people with untreated HIV-1 infection connected to acute transmission.


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