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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Phylogenetic insights into regional HIV transmission
AIDS, Volume 26, No. 14, Year 2012
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Description
OBJECTIVES: Despite prevention efforts, new HIV diagnoses continue in the southern United States, where the epidemic is characterized by significant racial/ethnic disparities. We integrated phylogenetic analyses with clinical data to reveal trends in local HIV transmission. DESIGN: Cross-sectional analysis of 1671 HIV-infected individuals each with one B-subtype pol sequence obtained during chronic (82%; UNC Center for AIDS Research Clinical Cohort) or acute/recent (18%; Duke/UNC Acute HIV Consortium) infection. METHODS: Phylogenies were inferred using neighbor joining to select related sequences then confirmed with Bayesian methods. We characterized transmission clusters (clades n≥3 sequences supported by posterior probabilities=1) by factors including race/ethnicity and transmission risk. Factors associated with cluster membership were evaluated for newly diagnosed patients. RESULTS: Overall, 72% were men, 59% black and 39% men who have sex with men (MSM). A total of 557 (33%) sequences grouped in either 108 pairs (n=216) or 67 clusters (n=341). Clusters ranged from three to 36 (median 4) members. Composition was delineated primarily by race, with 28% exclusively black, and to a lesser extent by risk group. Both MSM and heterosexuals formed discrete clusters, although substantial mixing was observed. In multivariable analysis, patients with age 30 years or less (P=0.009), acute infection (P=0.02), local residence (P=0.002) and transmitted drug resistance (P=0.02) were more likely to be cluster members, whereas Latinos were less likely (P<0.001). CONCLUSION: Integration of molecular, clinical and demographic data offers a unique view into the structure of local transmission networks. Clustering by black race, youth and transmitted drug resistance and inability to identify Latino clusters will inform prevention, testing and linkage to care strategies. © 2012 Wolters Kluwer Health | Lippincott Williams &Wilkins.
Authors & Co-Authors
Dennis, Ann M.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Hué, Stéphane
United Kingdom, London
University College London
Hurt, Christopher Browning
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Napravnik, Sonia
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Morris, Lynn G.
United Kingdom, London
University College London
Eron, Joseph J.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Statistics
Citations: 60
Authors: 6
Affiliations: 3
Identifiers
Doi:
10.1097/QAD.0b013e3283573244
ISSN:
14735571
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Participants Gender
Male