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Miranda MNS, Pingarilho M, Pimentel V, Martins MDRO, Vandamme AM, Bobkova M, Böhm M, Seguin-Devaux C, Paredes R, Rubio R, Zazzi M, Incardona F, Abecasis A. Determinants of HIV-1 Late Presentation in Patients Followed in Europe. Pathogens 2021; 10:pathogens10070835. [PMID: 34357985 PMCID: PMC8308660 DOI: 10.3390/pathogens10070835] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
To control the Human Immunodeficiency Virus (HIV) pandemic, the World Health Organization (WHO) set the 90-90-90 target to be reached by 2020. One major threat to those goals is late presentation, which is defined as an individual presenting a TCD4+ count lower than 350 cells/mm3 or an AIDS-defining event. The present study aims to identify determinants of late presentation in Europe based on the EuResist database with HIV-1 infected patients followed-up between 1981 and 2019. Our study includes clinical and socio-demographic information from 89851 HIV-1 infected patients. Statistical analysis was performed using RStudio and SPSS and a Bayesian network was constructed with the WEKA software to analyze the association between all variables. Among 89,851 HIV-1 infected patients included in the analysis, the median age was 33 (IQR: 27.0-41.0) years and 74.4% were males. Of those, 28,889 patients (50.4%) were late presenters. Older patients (>56), heterosexuals, patients originated from Africa and patients presenting with log VL >4.1 had a higher probability of being late presenters (p < 0.001). Bayesian networks indicated VL, mode of transmission, age and recentness of infection as variables that were directly associated with LP. This study highlights the major determinants associated with late presentation in Europe. This study helps to direct prevention measures for this population.
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Affiliation(s)
- Mafalda N. S. Miranda
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
- Correspondence: ; Tel.: +351-213-652-600
| | - Marta Pingarilho
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
| | - Victor Pimentel
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
| | - Maria do Rosário O. Martins
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
| | - Anne-Mieke Vandamme
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
- Laboratory Clinical and Epidemiological Virology, Department of Microbiology and Immunology, KU Leuven, Rega Institute for Medical Research, 3000 Leuven, Belgium
| | - Marina Bobkova
- Gamaleya Research Center of Epidemiology and Microbiology, Department of General Virology, Gamaleya Scientific Research Institute, 123098 Moscow, Russia;
| | - Michael Böhm
- Department of Medicine, Saarland University Hospital, 66421 Homburg, Germany;
| | - Carole Seguin-Devaux
- Laboratory of Retrovirology, Department of Infection and Immunity, Luxembourg Institute of Health, L-4354 Esch-sur-Alzette, Luxembourg;
| | - Roger Paredes
- Infectious Diseases Department and IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain;
| | - Rafael Rubio
- Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, 28026 Madrid, Spain;
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy;
| | - Francesca Incardona
- IPRO—InformaPRO S.r.l., 98, 00152 Rome, Italy;
- EuResist Network, 98/100, 00152 Rome, Italy
| | - Ana Abecasis
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
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Kostaki EG, Limnaios S, Roussos S, Psichogiou M, Nikolopoulos GK, Friedman SR, Antoniadou A, Chini M, Hatzakis A, Sypsa V, Magiorkinis G, Seguin-Devaux C, Paraskevis D. Validation of molecular clock inferred HIV infection ages: Evidence for accurate estimation of infection dates. INFECTION GENETICS AND EVOLUTION 2021; 91:104799. [PMID: 33677110 DOI: 10.1016/j.meegid.2021.104799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Improving HIV diagnosis, access to care and effective antiretroviral treatment provides our global strategy to reduce HIV incidence. To reach this goal we need to increase our knowledge about local epidemics. HIV infection dates would be an important information towards this goal, but they are largely unknown. To date, methods to estimate the dates of HIV infection are based mainly on laboratory or molecular methods. Our aim was to validate molecular clock inferred infection dates that were estimated by analysing sequences from 145 people living with HIV (PLHIV) with known transmission dates (clinically estimated infection dates). METHODS All HIV sequences were obtained by Sanger sequencing and were previously found to belong to well-established molecular transmission clusters (MTCs). RESULTS Our analysis showed that the molecular clock inferred infection dates were correlated with the clinically estimated ones (Spearman's Correlation coefficient = 0.93, p < 0.001) and that there was an agreement between them (Lin's concordance correlation coefficient = 0.92, p < 0.001). For the 61.4% of cases the molecular clock inferred preceded the clinically estimated infection dates. The median difference between clinically and molecularly estimated dates of infection was of 0.18 (IQR: -0.21, 0.89) years. The lowest differences were identified in people who inject drugs of our study population. CONCLUSIONS The estimated time to more recent common ancestor (tMRCA) of nodes within clusters provides a reliable approximation of HIV infections for PLHIV infected within MTCs. Next-generation sequencing data and molecular clock estimates based on heterochronous sequences provide, probably, more reliable methods for inferring infection dates. However, since these data are not available in most of the HIV clinical laboratories, our approach, under specific conditions, can provide a reliable estimation of HIV infection dates and can be used for HIV public health interventions.
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Affiliation(s)
- Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Limnaios
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Psichogiou
- 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Samuel R Friedman
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Anastasia Antoniadou
- 4th Department of Medicine, Attikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Chini
- 3rd Department of Internal Medicine-Infectious Diseases Unit, "Korgialeneio-Benakeio" Red Cross General Hospital, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Carole Seguin-Devaux
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch sur Alzette, Luxembourg
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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