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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Massive Iatrogenic Outbreak of Human Immunodeficiency Virus Type 1 in Rural Cambodia, 2014-2015
Clinical Infectious Diseases, Volume 66, No. 11, Year 2018
Notification
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Description
Background In 2014-2015, 242 individuals aged 2-89 years were newly diagnosed with human immunodeficiency virus type 1 (HIV-1) in Roka, a rural commune in Cambodia. A case-control study attributed the outbreak to unsafe injections. We aimed to reconstruct the likely transmission history of the outbreak. Methods We assessed in 209 (86.4%) HIV-infected cases the presence of hepatitis C virus (HCV) and hepatitis B virus (HBV). We identified recent infections using antibody (Ab) avidity testing for HIV and HCV. We performed amplification, sequencing, and evolutionary phylogenetic analyses of viral strains. Geographical coordinates and parenteral exposure through medical services provided by an unlicensed healthcare practitioner were obtained from 193 cases and 1499 controls during interviews. Results Cases were coinfected with HCV (78.5%) and HBV (12.9%). We identified 79 (37.8%) recent (<130 days) HIV infections. Phylogeny of 202 HIV env C2V3 sequences showed a 198-sample CRF01-AE strains cluster, with time to most recent common ancestor (tMRCA) in September 2013 (95% highest posterior density, August 2012-July 2014), and a peak of 15 infections/day in September 2014. Three geospatial HIV hotspots were discernible in Roka and correlated with high exposure to the practitioner (P =.04). Fifty-nine of 153 (38.6%) tested cases showed recent (<180 days) HCV infections. Ninety HCV NS5B sequences formed 3 main clades, 1 containing 34 subtypes 1b with tMRCA in 2012, and 2 with 51 subtypes 6e and tMRCAs in 2002-2003. Conclusions Unsafe injections in Cambodia most likely led to an explosive iatrogenic spreading of HIV, associated with a long-standing and more genetically diverse HCV propagation. © The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Rouet, François
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Nouhin, Janin
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Zheng, Duping
United States, Atlanta
Centers for Disease Control and Prevention
ROCHE, B.
France, Montpellier
Maladies Infectieuses et Vecteurs : Écologie, Génétique, Évolution et Contrôle
Black, Allison
United States, Seattle
Fred Hutchinson Cancer Center
Leoz, Marie
France, Caen
Gram 2.0 - Groupe de Recherche Sur L'adaptation Microbienne
Gaudy-Graffin, Catherine
France, Paris
Inserm
Ferradini, Laurent L.F.
Switzerland, Geneva
Organisation Mondiale de la Santé
Ken, Sreymom
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Kerléguer, Alexandra
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Yang, Chunfu
United States, Atlanta
Centers for Disease Control and Prevention
Killam, William Perry
United States, Atlanta
Centers for Disease Control and Prevention
Fontenille, Didier
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Barin, Françis
France, Paris
Inserm
Plantier, Jean Christophe
France, Caen
Gram 2.0 - Groupe de Recherche Sur L'adaptation Microbienne
Bedford, Trevor B.C.
United States, Seattle
Fred Hutchinson Cancer Center
Ramos, Artur C.
United States, Atlanta
Centers for Disease Control and Prevention
Saphonn, Vonthanak
Cambodia, Phnom Penh
University of Health Sciences
Statistics
Citations: 20
Authors: 18
Affiliations: 9
Identifiers
Doi:
10.1093/cid/cix1071
ISSN:
10584838
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Case-Control Study