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Bai C, Tan T, Li L, Lu R, Zhang W, Ouyang L, Wu G, Zhou C. Molecular network characteristics and drug resistance analysis of 392 newly reported MSM HIV/AIDS cases in Chongqing, China. Front Public Health 2024; 12:1308784. [PMID: 38903589 PMCID: PMC11187242 DOI: 10.3389/fpubh.2024.1308784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 05/23/2024] [Indexed: 06/22/2024] Open
Abstract
To comprehensively investigate the molecular transmission patterns of HIV-1 genotypes among men who have sex with men (MSM) in Chongqing, we employed 392 pol sequences of MSM to construct a phylogenetic tree and gene transmission network. Among the viral subtypes, CRF07_BC accounted for 73.2% (287/392) and CRF01_AE accounted for 20.7% (81/392), emerging as the predominant subtypes in this investigation. Additionally, we observed the presence of CRF55_01B, subtype B, CRF08_BC and other circulating recombinant forms. The HIV-1 molecular network was constructed with a gene distance threshold of 1.5%, resulting in an entry rate of 61.4% (241/392). Within the network, we identified a total of 23 molecular clusters, with the largest cluster being the CRF07_BC molecular cluster comprising 148 node values. Transmitted drug-resistance (TDR) mutations were found in 4.34% of the cases, with 1.79% associated with protease inhibitors (PIs), 0.51% with nucleoside reverse transcriptase inhibitors (NRTIs), and 2.55% with non-nucleoside reverse transcriptase inhibitors (NNRTIs). Statistical analysis indicated a higher enrollment rate in the HIV-1 molecular network among infected individuals with the CRF07_BC subtype, those identifying with same-sex sexual roles as "vers," and individuals with higher education levels. This suggests the need for strengthened investigation and intervention in this population to prevent the formation of larger transmission clusters. Furthermore, continuous monitoring of the HIV-1 molecular dynamics network is necessary to promptly and accurately track changes in molecular epidemic characteristics.
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Affiliation(s)
| | | | | | | | | | | | - Guohui Wu
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Chao Zhou
- Chongqing Center for Disease Control and Prevention, Chongqing, China
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Zhou Y, Lu J, Zhang Z, Sun Q, Xu X, Hu H. Characteristics of the different HIV-1 risk populations based on the genetic transmission network of the newly diagnosed HIV cases in Jiangsu, Eastern China. Heliyon 2023; 9:e22927. [PMID: 38125421 PMCID: PMC10730745 DOI: 10.1016/j.heliyon.2023.e22927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction The HIV-1 prevalence has been steadily increasing in Jiangsu, China. HIV-1 genetic transmission network can be used to explore the transmission kinetics and precision intervention in high-risk populations. Thus, we generated an HIV-1 genetic transmission network, explored key risk populations based on different risk factors and found out the risk factors for HIV-1 prevention and control among the newly-diagnosed HIV-1 cases from 2017 to 2018. Method We amplified the HIV-1 pol sequences from the plasma samples of the newly-diagnosed HIV-1 cases from 2017 to 2018 and obtained the infection data from The National HIV/AIDS Surveillance System. HIV-Trace and Cytoscape Software were both used to construct the HIV-1 genetic network with a gene distance of <0.005. The R software was used to analyze the risk factors for inclusion into the network. Results We obtained 3362 sequences with the pol gene region, of which 3316 contained detailed individual information. CRF01_AE accounted for 42.3 % of the HIV-1 subtypes in the samples. The median CD4+T lymphocyte count was 329 cells/μL in 2017 and 313 cells/μL in 2018. At the gene distance threshold of 0.005, 481 sequences were incorporated into the HIV-1 gene network, constructing 202 clusters. Age over 60 years old, heterosexual transmission route, subtype (CRF105_0107, CRF55_01 B, and CRF67_01 B) and CD4+T lymphocyte count (>200) were the risk factors influencing inclusion into the HIV-1 gene network. Moreover, south Jiangsu cities had higher inclusion in the network. Thus, key risk populations in the clusters with different transmission routes, new emerging subtypes, drug resistance nodes, and individuals above 60 years of age in the network represented the critical risk populations that should be focused more on for intervention. Conclusion The HIV-1 genetic transmission network is adept at discovering undiagnosed HIV-infected cases and linking all diagnosed cases for determination of risk infections. Therefore we should pay more attention to these risk infections with further investigation and intervention, helping to achieve the goal of 95 % use combination prevention from the World Health Organization, and push to end AIDS epidemic.
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Affiliation(s)
- Ying Zhou
- Institute of AIDS/STD Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Jing Lu
- Institute of AIDS/STD Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Zhi Zhang
- Institute of AIDS/STD Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Qi Sun
- Institute of AIDS/STD Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Xiaoqin Xu
- Institute of AIDS/STD Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Haiyang Hu
- Institute of AIDS/STD Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
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Wang Z, Wang D, Lin L, Qiu Y, Zhang C, Xie M, Lu X, Lian Q, Yan P, Chen L, Feng Y, Xing H, Wang W, Wu S. Epidemiological characteristics of HIV transmission in southeastern China from 2015 to 2020 based on HIV molecular network. Front Public Health 2023; 11:1225883. [PMID: 37942240 PMCID: PMC10629674 DOI: 10.3389/fpubh.2023.1225883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/04/2023] [Indexed: 11/10/2023] Open
Abstract
Objective HIV/AIDS remains a global public health problem, and understanding the structure of social networks of people living with HIV/AIDS is of great importance to unravel HIV transmission, propose precision control and reduce new infections. This study aimed to investigate the epidemiological characteristics of HIV transmission in Fujian province, southeastern China from 2015 to 2020 based on HIV molecular network. Methods Newly diagnosed, treatment-naive HIV/AIDS patients were randomly sampled from Fujian province in 2015 and 2020. Plasma was sampled for in-house genotyping resistance test, and HIV molecular network was created using the HIV-TRACE tool. Factors affecting the inclusion of variables in the HIV molecular network were identified using univariate and multivariate logistic regression analyses. Results A total of 1,714 eligible cases were finally recruited, including 806 cases in 2015 and 908 cases in 2020. The dominant HIV subtypes were CRF01_AE (41.7%) and CRF07_BC (38.3%) in 2015 and CRF07_BC (53. 3%) and CRF01_AE (29.1%) in 2020, and the prevalence of HIV drug resistance was 4.2% in 2015 and 5.3% in 2020. Sequences of CRF07_BC formed the largest HIV-1 transmission cluster at a genetic distance threshold of both 1.5 and 0.5%. Univariate and multivariate logistic regression analyses showed that ages of under 20 years and over 60 years, CRF07_BC subtype, Han ethnicity, sampling in 2015, absence of HIV drug resistance, married with spouse, sampling from three cities of Jinjiang, Nanping and Quanzhou resulted in higher proportions of sequences included in the HIV transmission molecular network at a genetic distance threshold of 1.5% (p < 0.05). Conclusion Our findings unravel the HIV molecular transmission network of newly diagnosed HIV/AIDS patients in Fujian province, southeastern China, which facilitates the understanding of HIV transmission patterns in the province.
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Affiliation(s)
- Zhenghua Wang
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, Fuzhou, China
| | - Dong Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Liying Lin
- Fuzhou Institute for Disease Control and Prevention of China Railway Nanchang Bureau Group Co., Ltd., Fuzhou, China
| | - Yuefeng Qiu
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, Fuzhou, China
| | - Chunyan Zhang
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, Fuzhou, China
| | - Meirong Xie
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, Fuzhou, China
| | - Xiaoli Lu
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, Fuzhou, China
| | - Qiaolin Lian
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, Fuzhou, China
| | - Pingping Yan
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, Fuzhou, China
| | - Liang Chen
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, Fuzhou, China
| | - Yi Feng
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Xing
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei Wang
- National Health Commission Key Laboratory for Parasitic Disease Prevention and Control, Jiangsu Provincial Key Laboratory for Parasites and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Shouli Wu
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, Fuzhou, China
- School of Public Health, Fujian Medical University, Fuzhou, China
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Li M, Zhou J, Zhang K, Yuan Y, Zhao J, Cui M, Yin D, Wen Z, Chen Z, Li L, Zou H, Deng K, Sun C. Characteristics of genotype, drug resistance, and molecular transmission network among newly diagnosed HIV-1 infections in Shenzhen, China. J Med Virol 2023; 95:e28973. [PMID: 37477806 DOI: 10.1002/jmv.28973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/19/2023] [Accepted: 07/08/2023] [Indexed: 07/22/2023]
Abstract
The HIV-1 pandemic has persisted for four decades, and poses a major challenge to global public health. Shenzhen, a city with large number of migrant populations in China, is suffering HIV-1 epidemic. It is necessary to continuously conduct the molecular surveillance among newly diagnosed HIV-1 patients in these migrant population. In this study, plasma samples of newly diagnosed and ART-naive HIV-1 infections were collected from Shenzhen city in China. The partial genes of HIV-1 gag and pol were amplified and sequenced for the analysis of genotype, drug resistance, and molecular transmission network. Ninety-one sequences of pol gene were obtained from newly diagnosed HIV-1 infections in Shenzhen, and seven HIV-1 subtypes were revealed in this investigation. Among them, the circulating recombinant form (CRF) 07_BC was the mostly frequent subtype (53.8%, 49/91), followed by CRF01_AE (20.9%, 19/91), CRF55_01B (9.9%, 9/91), unique recombinant forms (URFs) (8.8%, 8/91), B (3.3%, 3/91), CRF59_01B (2.2%, 2/91), and CRF08_BC (1.1%, 1/91). The overall prevalence of pretreatment drug resistance (PDR) was 23.1% (21/91), and 52.38% (11/21) of the PDR was specific for the nonnucleotide reverse transcriptase inhibitors (NNRTIs). Furthermore, a total of 3091 pol gene sequences were used to generate 19 molecular transmission clusters, and then one growing cluster, a new cluster, and a cluster with growth reactivation were identified. The result revealed that more sexual partner, CRF_07BC subtype, and seven amino acid deletions in gag p6 region might be the influencing factors associated with the high risk of transmission behavior. Compared with CRF01_AE subtype, CRF07_BC subtype strains were more likely to form clusters in molecular transmission network. This suggests that long-term surveillance of the HIV-1 molecular transmission should be a critical measure to achieve a precise intervention for controlling the spread of HIV-1 in China.
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Affiliation(s)
- Minchao Li
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Jiasheng Zhou
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Kechun Zhang
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Yue Yuan
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Jiacong Zhao
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Mingting Cui
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Di Yin
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Ziyu Wen
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Zhonghe Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Linghua Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Kai Deng
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Disease Control (Sun Yat-sen University), Ministry of Education, Guangzhou, China
| | - Caijun Sun
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
- Key Laboratory of Tropical Disease Control (Sun Yat-sen University), Ministry of Education, Guangzhou, China
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Hallmark CJ, Luswata C, Del Vecchio N, Hayford C, Mora R, Carr M, McNeese M, Benbow N, Schneider JA, Wertheim JO, Fujimoto K. Predictors of HIV Molecular Cluster Membership and Implications for Partner Services. AIDS Res Hum Retroviruses 2023; 39:241-252. [PMID: 36785940 PMCID: PMC10171944 DOI: 10.1089/aid.2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Public health surveillance data used in HIV molecular cluster analyses lack contextual information that is available from partner services (PS) data. Integrating these data sources in retrospective analyses can enrich understanding of the risk profile of people in clusters. In this study, HIV molecular clusters were identified and matched to information on partners and other information gleaned at the time of diagnosis, including coinfection with syphilis. We aimed to produce a more complete understanding of molecular cluster membership in Houston, Texas, a city ranking ninth nationally in rate of new HIV diagnoses that may benefit from retrospective matched analyses between molecular and PS data to inform future intervention. Data from PS were matched to molecular HIV records of people newly diagnosed from 2012 to 2018. By conducting analyses in HIV-TRACE (TRAnsmission Cluster Engine) using viral genetic sequences, molecular clusters were detected. Multivariable logistic regression models were used to estimate the association between molecular cluster membership and completion of a PS interview, number of named partners, and syphilis coinfection. Using data from 4,035 people who had a viral genetic sequence and matched PS records, molecular cluster membership was not significantly associated with completion of a PS interview. Among those with sequences who completed a PS interview (n = 3,869), 45.3% (n = 1,753) clustered. Molecular cluster membership was significantly associated with naming 1 or 3+ partners compared with not naming any partners [adjusted odds ratio, aOR: 1.27 (95% confidence interval, CI: 1.08-1.50), p = .003 and aOR: 1.38 (95% CI: 1.06-1.81), p = .02]. Alone, coinfection with syphilis was not significantly associated with molecular cluster membership. Syphilis coinfection was associated with molecular cluster membership when coupled with incarceration [aOR: 1.91 (95% CI: 1.08-3.38), p = .03], a risk for treatment interruption. Enhanced intervention among those with similar profiles, such as people coinfected with other risks, may be warranted.
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Affiliation(s)
- Camden J. Hallmark
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Houston Health Department, Houston, Texas, USA
| | - Charles Luswata
- Houston Health Department, Houston, Texas, USA
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Natascha Del Vecchio
- Department of Medicine and Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Christina Hayford
- Third Coast Center for AIDS Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | | | | | - Nanette Benbow
- Third Coast Center for AIDS Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - John A. Schneider
- Department of Medicine and Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Joel O. Wertheim
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Kayo Fujimoto
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Wang N, Lan G, Zhu Q, Chen H, Huang J, Meng Q, Shen Z, Liang S, Wu X, Luo L, Ye R, Chen J, Tan S, Xing H, Shao Y, Ruan Y, Lin M. HIV Epidemiology, Care, and Treatment Outcomes Among Student and Nonstudent Youths Living With HIV in Southwest China Between 1996 and 2019: Historical Cohort Study. JMIR Public Health Surveill 2023; 9:e38881. [PMID: 36826980 PMCID: PMC10007008 DOI: 10.2196/38881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/13/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Nearly one-third of new HIV infections occurred among youth in 2019 worldwide. Previous studies suggested that student youths living with HIV and nonstudent youths living with HIV might differ in some risk factors, transmission routes, HIV care, and disease outcomes. OBJECTIVE This study aimed to compare the HIV epidemic, disease outcomes, and access to care among student and nonstudent youths living with HIV aged 16 to 25 years in Guangxi, China. METHODS We performed a historical cohort study by extracting data on all HIV or AIDS cases aged 16 to 25 years in Guangxi, China, during 1996-2019 from the Chinese Comprehensive Response Information Management System of HIV or AIDS. We conducted analyses to assess possible differences in demographic and behavioral characteristics, HIV care, and disease outcomes between student and nonstudent youths living with HIV. Multivariate Cox regression was used to assess differences in mortality and virologic failure between student and nonstudent cases. RESULTS A total of 13,839 youths aged 16 to 25 years were infected with HIV during 1996-2019. Among them, 10,202 cases were infected through sexual contact, most of whom were men (n=5507, 54%); 868 (8.5%) were students, and 9334 (91.5%) were not students. The number of student youths living with HIV was lower before 2006 but gradually increased from 2007 to 2019. In contrast, the nonstudent cases increased rapidly in 2005, then gradually declined after 2012. Student cases were mainly infected through homosexual contact (n=614, 70.7% vs n=1447, 15.5%; P<.001), while nonstudent cases were more likely to be infected through heterosexual contact (n=7887, 84.5% vs n=254, 29.3%; P<.001). Moreover, nonstudent cases had a significantly lower CD4 count than student cases at the time of HIV diagnosis (332 vs 362 cells/μL; P<.001). Nonstudents also had a delayed antiretroviral therapy (ART) initiation compared to students (93 days vs 22 days; P<.001). Furthermore, the mortality rate of 0.4 and 1.0 deaths per 100 person-years were recorded for student and nonstudent youths with HIV, respectively. Overall, the mortality risk in nonstudent cases was 2.3 times that of student cases (adjusted hazard ratio [AHR] 2.3, 95% CI 1.2-4.2; P=.008). The virologic failure rate was 2.3 and 2.6 per 100 person-years among student and nonstudent youths living with HIV, respectively. Nonstudent cases had double the risk of virologic failure compared to student cases (AHR 1.9, 95% CI 1.3-2.6; P<.001). CONCLUSIONS Nonstudent youths living with HIV might face a low CD4 count at the time of HIV diagnosis, delayed ART initiation, and increased risk of death and virologic failure. Thus, HIV prevention and interventions should target youths who dropped out of school early to encourage safe sex and HIV screening, remove barriers to HIV care, and promote early ART initiation to curb the HIV epidemic among youths.
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Affiliation(s)
- Na Wang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China.,Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, School of Public Health, Guilin Medical University, Guilin, China
| | - Guanghua Lan
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Qiuying Zhu
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Huanhuan Chen
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Jinghua Huang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Qin Meng
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Zhiyong Shen
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Shujia Liang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Xiuling Wu
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Liuhong Luo
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Rongyi Ye
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, School of Public Health, Guilin Medical University, Guilin, China
| | - Jinli Chen
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, School of Public Health, Guilin Medical University, Guilin, China
| | - Shengkui Tan
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, School of Public Health, Guilin Medical University, Guilin, China
| | - Hui Xing
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Mei Lin
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
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Wang X, Zhang T, Chang Q, Wang C, Wang K, Yu Z, Zhang H, Huang H, Song D, Peixoto E, Yang J, Li C, Cui Z, Liu Y, Ma J. The risk of acute and early HIV (AEH) infection among MSM with different behaviour trajectories: an open cohort study in Tianjin, China, 2011-2019. BMC Infect Dis 2023; 23:37. [PMID: 36670349 PMCID: PMC9862950 DOI: 10.1186/s12879-023-08001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Acute and early HIV (AEH) infection is characterized by a high viral load and infectivity. Approximately 50% of cases of HIV-1 transmission occur during AEH. Understanding sexual behaviour trajectories would be useful for predicting changes in the risk of HIV acquisition. However, few studies have investigated sexual behaviour trajectories and their association with AEH acquisition. This study identified behaviour trajectories among men who have sex with men (MSM), determined the risk of AEH infection, and compared risk factors between different behaviour trajectories. METHODS The study was based on an ongoing prospective open cohort of voluntary HIV counselling and testing (VHCT) among MSM in Tianjin, China. From 2011 to 2019, 1974 MSM were recruited. Group-based trajectory modelling (GBTM) was used to identify behaviour trajectories by constructing a sexual risk behaviour score. Logistic regression and generalized estimating equation (GEE) were used to compare the risk of AEH infection and risk factors for different behaviour trajectories. All data analyses were performed using SAS 9.4. RESULTS The incidence of AEH infection was 1.76/100 person-years, with 64 AEH infections documented in 3633 person-years of follow-up. Three sexual behaviour trajectories were identified: CL (consistently low risk, 35.46%), CH (consistently high risk, 42.71%) and HTL (high to low risk, 21.83%). MSM in the HTL and CH groups had higher AEH infection rates than MSM in the CL group (6.73%, 3.08% and 1.28%, respectively), with ORs of 5.54 (2.60, 11.82) and 2.44 (1.14, 5.25), respectively. MSM aged 30-50 years old and MSM who underwent HIV testing in the last year were more likely to be in the CH group and HTL group. In addition, the HTL group was characterized by a lower likelihood of local registration and a higher likelihood of working as a MSW. CONCLUSION MSM in the CH group and the HTL group had a higher risk of AEH infection. In the future, VHCT should be performed more often among younger MSM, and HIV counselling should be given the same priority as HIV testing. In addition, VHCT combined with PrEP may have a better preventive impact on MSM with a high risk of AEH infection.
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Affiliation(s)
- Xiaomeng Wang
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Tiantian Zhang
- grid.506261.60000 0001 0706 7839Medical Service Division, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Qinxue Chang
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Chun Wang
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Keyun Wang
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Zeyang Yu
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Honglu Zhang
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Huijie Huang
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Desheng Song
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Elissa Peixoto
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Jie Yang
- “Shenlan” Public Health Counseling Service Center, Tianjin, China
| | - Changping Li
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Zhuang Cui
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Yuanyuan Liu
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Jun Ma
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
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Pan W, Gao N, Hu B, Yin Y, Shen Y, Yang X, Wei W, Ni J, Dai S, Miao L, Qin Y, Jin L, Guo H, Wu J. The characteristics of HIV-1 subtype B on phylogenetic dynamic and molecular transmission network in Fuyang City, China, 2011 to 2019. Front Public Health 2023; 11:1092376. [PMID: 36935727 PMCID: PMC10015982 DOI: 10.3389/fpubh.2023.1092376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction HIV-1 subtype B, as once one of the earliest strains introduced into mainland China rapidly spread in commercial plasma donors and heterosexuals in 1990s. Here, we aim to investigate the origin and evolutionary history of HIV-1 subtype B in Fuyang city, China. Methods We collected sequences tested from Fuyang in the east of China where higher prevalence of HIV-1 among commercial plasma donors and heterosexuals to construct a phylogenetic tree using the Markov chain Monte Carlo (MCMC) algorithm, infer molecular transmission network using TN93 model and visualize it with Cytoscape software. Results and discussion Our results showed that >99% of subtype B sequences belonged to Thai B. The sequences from Fuyang often cluster closer to those from other its adjacent cities, which clustered together and formed a monophyletic cluster. HIV-1 B circulating in Fuyang dates back to approximately 1990. Among the 1,437 sequences, 166 clustered at a genetic distance of ≤1.2%, resulting in 73 clusters. The degree of clustering with at least one other person was 11.55%. Among the transmission clusters, 50 (80.65%) comprised two individuals. Most clusters consisted of both heterosexual transmission routes and men who have sex with men. Phylogenetic and molecular network analyses revealed a common origin with neighboring regions in mainland China, local onwards transmission after its introduction, and a limited clustering degree. However, at least two co-existing transmission routes in most transmission clusters imply a greater challenge in controlling the spread of HIV-1. Our findings highlight the value on tailoring prevention interventions by combination of molecular surveillance and epidemiology.
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Affiliation(s)
- Wenting Pan
- Anhui No. 2 Provincial People's Hospital, Hefei, China
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei, China
| | - Nannan Gao
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei, China
| | - Bing Hu
- Department of AIDS Prevention and Control, Fuyang Center for Disease Control and Prevention, Fuyang, China
| | - Yueqi Yin
- School of Medicine, Ningbo University, Ningbo, China
| | - Yuelan Shen
- Department of AIDS Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Xiaohui Yang
- Department of AIDS Prevention and Control, Fuyang Center for Disease Control and Prevention, Fuyang, China
| | - Wei Wei
- Department of AIDS Prevention and Control, Fuyang Center for Disease Control and Prevention, Fuyang, China
| | - Jie Ni
- Department of AIDS Prevention and Control, Fuyang Center for Disease Control and Prevention, Fuyang, China
| | - Seying Dai
- Department of AIDS Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Lifeng Miao
- Department of AIDS Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Yizu Qin
- Department of AIDS Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Lin Jin
- Department of AIDS Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Hongxiong Guo
- NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
- *Correspondence: Hongxiong Guo
| | - Jianjun Wu
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei, China
- Department of AIDS Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
- Jianjun Wu
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A New HIV-1 K 28E 32-Reverse Transcriptase Variant Associated with the Rapid Expansion of CRF07_BC among Men Who Have Sex with Men. Microbiol Spectr 2022; 10:e0254522. [PMID: 36214682 PMCID: PMC9604004 DOI: 10.1128/spectrum.02545-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
HIV-1 CRF07_BC originated among injection drug users (IDUs) in China. After diffusing into men who have sex with men (MSM), CRF07_BC has shown a rapid expansion in this group; however, the mechanism remains unclear. Here, we identified a new K28E32 variant of CRF07_BC that was characterized by five specific mutations (E28K, K32E, E248V, K249Q, and T338S) in reverse transcriptase. This variant was mainly prevalent among MSM, and was overrepresented in transmission clusters, suggesting that it could have driven the rapid expansion of CRF07_BC in MSM, though founder effects cannot be ruled out. It was descended from an evolutionary intermediate accumulating four specific mutations and formed an independent phylogenetic node with an estimated origin time in 2003. The K28E32 variant was demonstrated to have significantly higher in vitro HIV-1 replication ability than the wild type. Mutations E28K and K32E play a critical role in the improvement of in vitro HIV-1 replication ability, reflected by improved reverse transcription activity. The results could allow public health officials to use this marker (especially E28K and K32E mutations in the reverse transcriptase (RT) coding region) to target prevention measures prioritizing MSM population and persons infected with this variant for test and treat initiatives. IMPORTANCE HIV-1 has very high mutation rate that is correlated with the survival and adaption of the virus. The variants with higher transmissibility may be more selective advantage than the strains with higher virulence. Several HIV-1 variants were previously demonstrated to be correlated with higher viral load and lower CD4 T cell count. Here, we first identified a new variant (the K28E32 variant) of HIV-1 CRF07_BC, described its origin and evolutionary dynamics, and demonstrated its higher in vitro HIV-1 replication ability than the wild type. We demonstrated that five RT mutations (especially E28K and K32E) significantly improve in vitro HIV-1 replication ability. The appearance of the new K28E32 variant was associated with the rapidly increasing prevalence of CRF07_BC among MSM.
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Hui S, Chen F, Li Y, Cui Y, Zhang J, Zhang L, Yang Y, Liu Y, Zhao Y, Lv F. Factors Associated With Newly HIV Infection and Transmitted Drug Resistance Among Men Who Have Sex With Men in Harbin, P.R. China. Front Public Health 2022; 10:860171. [PMID: 35719611 PMCID: PMC9201057 DOI: 10.3389/fpubh.2022.860171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed to evaluate HIV incidence, factors associated with HIV incidence and transmitted drug resistance (TDR) among newly infected men who have sex with men (MSM) in Harbin, P.R. China. Methods A cohort study was conducted among MSM in Harbin during 2013 and 2018, with a follow-up frequency of every 6 months. Blood samples from MSM were tested for HIV antibodies, RNA was extracted from plasma, and the pol gene was sequenced, and genotypic drug-resistance analyses were performed. Results From 2013 to 2018, the overall rate of HIV incidence was 3.55/100 PY. Syphilis infection, unprotected sex with men in the past 6 months, and unawareness of HIV/AIDS knowledge were risk factors for HIV seroconversion. The distribution of HIV genotypes was as follows: CRF01_AE, 57.1%; CRF07_BC, 28.5%; CRF55_01B, 2.0%; B, 8.2%. The prevalence of transmitted drug resistance was 4.08%. Conclusion HIV incidence in MSM in Harbin is moderately high, and transmitted drug resistance exists in the population.
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Affiliation(s)
- Shan Hui
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, China.,Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, China
| | - Fangfang Chen
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yi Li
- Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, China
| | - Yan Cui
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinhui Zhang
- Jixi Municipal Center for Disease Control and Prevention, Harbin, China
| | - Ling Zhang
- Harbin Municipal Center for Disease Control and Prevention, Harbin, China
| | - Yisi Yang
- Harbin Municipal Center for Disease Control and Prevention, Harbin, China
| | - Yanlin Liu
- Harbin Municipal Center for Disease Control and Prevention, Harbin, China
| | - Yashuang Zhao
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, China
| | - Fan Lv
- Chinese Center for Disease Control and Prevention, Beijing, China
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11
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Gore DJ, Schueler K, Ramani S, Uvin A, Phillips G, McNulty M, Fujimoto K, Schneider J. HIV Response Interventions that Integrate HIV Molecular Cluster and Social Network Analysis: A Systematic Review. AIDS Behav 2022; 26:1750-1792. [PMID: 34779940 PMCID: PMC9842229 DOI: 10.1007/s10461-021-03525-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 01/19/2023]
Abstract
Due to improved efficiency and reduced cost of viral sequencing, molecular cluster analysis can be feasibly utilized alongside existing human immunodeficiency virus (HIV) prevention strategies. The goal of this paper is to elucidate how HIV molecular cluster and social network analyses are being integrated to implement HIV response interventions. We searched PubMed, Scopus, PsycINFO, and Cochrane Library databases for studies incorporating both HIV molecular cluster and social network data. We identified 32 articles that combined analyses of HIV molecular sequences and social or sexual networks. All studies were descriptive. Six studies described network interventions informed by molecular and social data but did not fully evaluate their efficacy. There is no current standard for incorporating molecular and social network analyses to inform interventions or data demonstrating its utility. More research must be conducted to delineate benefits and best practices for leveraging molecular data for network-based interventions.
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Affiliation(s)
- Daniel J Gore
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kellie Schueler
- Department of Obstetrics and Gynecology, University of California San Diego, San Diego, CA, USA
| | - Santhoshini Ramani
- The Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Arno Uvin
- The Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Moira McNulty
- The Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
| | - John Schneider
- The Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL, USA.
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12
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Yuan D, Yu B, Liang S, Fei T, Tang H, Kang R, Li Y, Ye L, Jia P, Yang S. HIV-1 genetic transmission networks among people living with HIV/AIDS in Sichuan, China: a genomic and spatial epidemiological analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 18:100318. [PMID: 35024655 PMCID: PMC8669382 DOI: 10.1016/j.lanwpc.2021.100318] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 09/11/2021] [Accepted: 10/15/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Spatialized HIV genetic transmission networks can help understand dynamic changes of HIV-1 at the regional level. This study aimed to combine genomic, epidemiological, and spatial data to investigate the patterns of the HIV-1 epidemic at both individual and regional levels among people living with HIV (PLWH) with virological failure of antiretroviral therapy (ART). METHODS We evaluated the transmission patterns of 5,790 PLWH with identified pol sequences of the five main HIV-1 subtypes (B, CRF08_BC, CRF85_BC, CRF07_BC, and CRF01_AE) in Sichuan Province, China. A phylogenetic cluster was defined as a group of sequences with genetically similar HIV strains, with all phylogenetic clusters forming an HIV-1 genetic transmission network for each subtype. Logistic regression was used to identify the potential risk factors for phylogenetic clustering. Spatial analysis was applied to demonstrate the geographic patterns of phylogenetic clustering rates; intensity matrices and flow maps were made to demonstrate the intensity of transmission within and between cities. FINDINGS There were 2,159 (37.3%) of 5,790 PLWH, distributed in 452 phylogenetic clusters. Some individual clinical and behavioral factors were associated with phylogenetic clustering, including a viral load of >50,000 copies/ml (OR=1.16, 95%CI=1.02-1.33), infection of other sexually transmitted diseases (OR=1.38, 95%CI=1.12-1.69), and ≥5 non-marital sexual partners (OR=1.25, 95%CI=1.03-1.51), while >3 years of treatment since the initial ART was associated with less likelihood of phylogenetic clustering (OR=0.82, 95%CI=0.70-0.97). The phylogenetic clustering rates varied regionally and were highest in the central region of Sichuan, especially for subtype CRF08_BC. The significant spatial clusters of high and low phylogenetic clustering rates were detected in the east (Dazhou for B; Zigong and Luzhou for CFR08_BC) and west (Yaan and Ganzi for CRF07_BC), respectively. The proportion of intercity transmission varied across cities from 0.14 (Yibin) and 1.00 (Ganzi). Stronger intercity transmission than average existed between some cities, e.g., between Deyang and Neijiang. CRF07_BC was the most widespread subtype between cities, and CRF85_BC (a novel HIV-1 subtype) showed strong intercity transmission (e.g., between Yibin and Guangan). INTERPRETATION The phylogenetic clustering rates and intercity connections of HIV-1 have varied geographically, possibly due to varying human mobility, traffic convenience, and economic activities. Our findings enhanced the understanding of the dynamics of HIV-1 transmission from individual to city level, and demonstrated a novel cross-disciplinary (epidemiological, genetic, and spatial) approach by which we identified high-risk populations and areas. Our approach could be adapted to other regions for precision public health interventions. FUNDING The National Natural Science Foundation of China, Sichuan Science and Technology Program, Project of Sichuan Provincial Health Committee, Science and Technology Project of Sichuan Provincial Health Committee, Wuhan University 351 Talent Program, 2020, and the International Institute of Spatial Lifecourse Epidemiology (ISLE).
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Affiliation(s)
- Dan Yuan
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Bin Yu
- West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shu Liang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Teng Fei
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
| | - Houlin Tang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Rui Kang
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
| | - Yiping Li
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Li Ye
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China
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13
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Zheng S, Wu J, Hu Z, Gan M, Liu L, Song C, Lei Y, Wang H, Liao L, Feng Y, Shao Y, Ruan Y, Xing H. Epidemiology and Molecular Transmission Characteristics of HIV in the Capital City of Anhui Province in China. Pathogens 2021; 10:pathogens10121554. [PMID: 34959509 PMCID: PMC8708547 DOI: 10.3390/pathogens10121554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 01/29/2023] Open
Abstract
Hefei, Anhui province, is one of the cities in the Yangtze River Delta, where many people migrate to Jiangsu, Zhejiang and Shanghai. High migration also contributes to the HIV epidemic. This study explored the HIV prevalence in Hefei to provide a reference for other provinces and assist in the prevention and control of HIV in China. A total of 816 newly reported people with HIV in Hefei from 2017 to 2020 were recruited as subjects. HIV subtypes were identified by a phylogenetic tree. The most prevalent subtypes were CRF07_BC (41.4%), CRF01_AE (38.1%) and CRF55_01B (6.3%). Molecular networks were inferred using HIV-TRACE. The largest and most active transmission cluster was CRF55_01B in Hefei’s network. A Chinese national database (50,798 sequences) was also subjected to molecular network analysis to study the relationship between patients in Hefei and other provinces. CRF55_01B and CRF07_BC-N had higher clustered and interprovincial transmission rates in the national molecular network. People with HIV in Hefei mainly transmitted the disease within the province. Finally, we displayed the epidemic trend of HIV in Hefei in recent years with the dynamic change of effective reproductive number (Re). The weighted overall Re increased rapidly from 2012 to 2015, with a peak value of 3.20 (95% BCI, 2.18–3.85). After 2015, Re began to decline and remained stable at around 1.80. In addition, the Re of CRF55_01B was calculated to be between 2.0 and 4.0 in 2018 and 2019. More attention needs to be paid to the rapid spread of CRF55_01B and CRF07_BC-N strains among people with HIV and the high Re in Hefei. These data provide necessary support to guide the targeted prevention and control of HIV.
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Affiliation(s)
- Shan Zheng
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (S.Z.); (M.G.); (L.L.); (C.S.); (L.L.); (Y.F.); (Y.S.); (Y.R.)
| | - Jianjun Wu
- Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China;
| | - Zhongwang Hu
- Hefei Center for Disease Control and Prevention, Hefei 230061, China; (Z.H.); (Y.L.); (H.W.)
| | - Mengze Gan
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (S.Z.); (M.G.); (L.L.); (C.S.); (L.L.); (Y.F.); (Y.S.); (Y.R.)
| | - Lei Liu
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (S.Z.); (M.G.); (L.L.); (C.S.); (L.L.); (Y.F.); (Y.S.); (Y.R.)
| | - Chang Song
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (S.Z.); (M.G.); (L.L.); (C.S.); (L.L.); (Y.F.); (Y.S.); (Y.R.)
| | - Yanhua Lei
- Hefei Center for Disease Control and Prevention, Hefei 230061, China; (Z.H.); (Y.L.); (H.W.)
| | - Hai Wang
- Hefei Center for Disease Control and Prevention, Hefei 230061, China; (Z.H.); (Y.L.); (H.W.)
| | - Lingjie Liao
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (S.Z.); (M.G.); (L.L.); (C.S.); (L.L.); (Y.F.); (Y.S.); (Y.R.)
| | - Yi Feng
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (S.Z.); (M.G.); (L.L.); (C.S.); (L.L.); (Y.F.); (Y.S.); (Y.R.)
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (S.Z.); (M.G.); (L.L.); (C.S.); (L.L.); (Y.F.); (Y.S.); (Y.R.)
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (S.Z.); (M.G.); (L.L.); (C.S.); (L.L.); (Y.F.); (Y.S.); (Y.R.)
| | - Hui Xing
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (S.Z.); (M.G.); (L.L.); (C.S.); (L.L.); (Y.F.); (Y.S.); (Y.R.)
- Correspondence:
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14
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Blassel L, Zhukova A, Villabona-Arenas CJ, Atkins KE, Hué S, Gascuel O. Drug resistance mutations in HIV: new bioinformatics approaches and challenges. Curr Opin Virol 2021; 51:56-64. [PMID: 34597873 DOI: 10.1016/j.coviro.2021.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 12/11/2022]
Abstract
Drug resistance mutations appear in HIV under treatment pressure. Resistant variants can be transmitted to treatment-naive individuals, which can lead to rapid virological failure and can limit treatment options. Consequently, quantifying the prevalence, emergence and transmission of drug resistance is critical to effectively treating patients and to shape health policies. We review recent bioinformatics developments and in particular describe: (1) the machine learning approaches intended to predict and explain the level of resistance of HIV variants from their sequence data; (2) the phylogenetic methods used to survey the emergence and dynamics of resistant HIV transmission clusters; (3) the impact of deep sequencing in studying within-host and between-host genetic diversity of HIV variants, notably regarding minority resistant variants.
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Affiliation(s)
- Luc Blassel
- Unité Bioinformatique Evolutive, Institut Pasteur, Paris, France; Sorbonne Université, Collège Doctoral, Paris, France
| | - Anna Zhukova
- Unité Bioinformatique Evolutive, Institut Pasteur, Paris, France; Hub de Bioinformatique et Biostatistique, Institut Pasteur, Paris, France
| | - Christian J Villabona-Arenas
- Centre for the Mathematical Modelling of Infectious Diseases (CMMID), London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Katherine E Atkins
- Centre for the Mathematical Modelling of Infectious Diseases (CMMID), London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stéphane Hué
- Centre for the Mathematical Modelling of Infectious Diseases (CMMID), London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Olivier Gascuel
- Institut de Systématique, Evolution, Biodiversité (ISYEB, UMR 7205 - CNRS, Muséum National d'Histoire Naturelle, EPHE, SU, UA), Paris, France.
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15
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Yang J, Han Z, Xu H, Xing H, Xu P, Cheng W, Gu Y, Lyu F. Identifying the Key Nodes of HIV Molecular Transmission Network Among Men Who Have Sex with Men - Guangzhou, Guangdong Province, China, 2015-2017. China CDC Wkly 2021; 3:803-807. [PMID: 34594994 PMCID: PMC8477060 DOI: 10.46234/ccdcw2021.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/15/2021] [Indexed: 11/24/2022] Open
Abstract
What is already known about this topic? Identifying the most influential spreaders in human immunodeficiency virus (HIV) transmission networks is crucial for developing effective prevention strategies. What is added by this report? This study identified key nodes of the HIV molecular transmission network among men who have sex with men (MSM) by utilizing linkages between sequences to reconstruct the transmission network at the molecular level. What are the implications for public health practice? This study could act as an important supplement of laboratory results to epidemiological studies and suggests that interdisciplinary research could inspire new ideas for finding breakthroughs on HIV/acquired immunodeficiency syndrome (AIDS) prevention and control.
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Affiliation(s)
- Juan Yang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhigang Han
- Department of HIV/AIDS Control and Prevention, Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Huifang Xu
- Department of HIV/AIDS Control and Prevention, Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Hui Xing
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Xu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Weibin Cheng
- Department of HIV/AIDS Control and Prevention, Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Yuzhou Gu
- Department of HIV/AIDS Control and Prevention, Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Fan Lyu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Abstract
OBJECTIVE The WHO has recommended that antiretroviral therapy be provided to all HIV patients to reduce future HIV transmission rates. However, few studies have examined this public health strategy at the population level in a real-world setting. METHODS In this longitudinal genetic-network study in Guangxi, China, the baseline and follow-up data were collected from HIV patients in 2014 and newly diagnosed HIV patients from 2015 to 2018, respectively. The prevention efficacy was used to estimate the effect of treatment-as-prevention in reducing HIV secondary transmission. RESULTS Among 804 newly diagnosed HIV patients during 2015-2018, 399 (49.6%) of them genetically linked to HIV patients at baseline during 2014-2017. The overall proportion of genetic linkage between newly diagnosed HIV patients during 2015-2018 with untreated and treated HIV patients at baseline during 2014-2017 was 6.2 and 2.9%, respectively. The prevention efficacy in HIV transmission for treated HIV patients was 53.6% [95% confidence interval (95% CI): 42.1-65.1]. Subgroup analyses indicated an 80.3% (95% CI: 74.8-85.8) reduction in HIV transmission among HIV patients who were treated for 4 years or more and had viral loads less than 50 copies/ml. There was no significant reduction in HIV transmission among treated HIV patients who dropped out or who had missing viral load measures. CONCLUSION Our study results support the feasibility of treating all HIV patients for future reductions in HIV transmission at the population level in real-world settings. Comprehensive intervention prevention programmes are urgently needed.
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Pagkas-Bather J, Young LE, Chen YT, Schneider JA. Social Network Interventions for HIV Transmission Elimination. Curr HIV/AIDS Rep 2021; 17:450-457. [PMID: 32720253 PMCID: PMC7497372 DOI: 10.1007/s11904-020-00524-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose of Review Network interventions for HIV prevention represent a potential area for growth in a globalizing world, where persons are more easily connected to one another through social media and networking applications. The basic tenets of network interventions such as (1) selection of a change agent, (2) segmentation, (3) induction, and (4) alteration represent myriad ways to structure network interventions for HIV prevention with the potential for large public health impact. Recent Findings Recent studies have employed the use of social networking websites such as Facebook to identify key persons to recruit others and disseminate information aimed at decreasing HIV transmission and improving safe sex practices among groups who are more vulnerable to HIV acquisition. Many of these interventions have successfully decreased HIV risk behaviors as well as decreased the spread of HIV among intervention cohorts. Summary Network interventions for HIV prevention provide more opportunities to reach populations who have not been reached through typical efforts employed in clinical and public health settings, though they are not currently widely employed by the public health community and other stakeholders.
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Affiliation(s)
- Jade Pagkas-Bather
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA. .,Chicago Center for HIV Elimination, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.
| | - Lindsay E Young
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.,Chicago Center for HIV Elimination, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA
| | - Yen-Tyng Chen
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.,Chicago Center for HIV Elimination, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.,Chicago Center for HIV Elimination, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.,Department of Public Health Sciences, University of Chicago, Chicago, IL, 60637, USA
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18
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Zhang K, Wei B, Tang Z, Wei Y, Zhao Z, Li D, Tao C. Acute HIV infection in a large teaching hospital in western China: Clinical, virological, and molecular epidemiological characteristics. J Med Virol 2020; 92:3288-3294. [PMID: 32644261 DOI: 10.1002/jmv.26282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 06/27/2020] [Accepted: 07/01/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To provide information on clinical, virological, and molecular epidemiological characteristics for early identification, diagnosis, and treatment of acute HIV infection (AHI). METHODS A retrospective study was conducted with patients with AHI from 2012 to 2017 in West China Hospital. RESULTS A total of 47 patients with AHI were found using a fourth-generation kit. Thirteen (27.66%) of these patients were negative if tested by third-generation tests. Median age of patients with AHI was 26 and 91.49% of them were males. Homosexual contact was responsible for 46.81% of AHI transmission. Among the individuals with AHI, 80.85% were outpatients. Common symptoms/signs were fever, headache, rash, cough and sputum, and sore throat. The syphilis coinfection rate was 17.24%. Most of the AHI was distributed in Fiebig stages IV (61.70%) and II (27.66%) with different clinical and virological characteristics. The increasing trend of cut-off index values was obvious in the course of AHI, helpful for auxiliary diagnosis. The main genetic forms of AHI were CRF07_BC and CRF01_AE, and a rare subtype CRF55_01B in Sichuan province was found. The drug resistance mutation rate was relatively high (17.65%) and five different mutations were identified. CONCLUSIONS Fourth-generation assays are strongly recommended for screening AHI compared to third-generation ones. Different clinical and virological characteristics in different Fiebig stages were found. Young individuals and outpatients were the majority of patients with AHI and this deserves special attention. Attention should also be paid to the rare CRF55_01B in Sichuan province and surveillance of HIV resistance ought to be strengthened.
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Affiliation(s)
- Keyi Zhang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Bin Wei
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Zhuoyun Tang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yinhao Wei
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Zhongyi Zhao
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Dongdong Li
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Chuanmin Tao
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
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Silva ÁMDCE, Reis MNDG, Marinho TA, de Freitas NR, Teles SA, de Matos MAD, Carneiro MADS, Bello G, Stefani MMA, Martins RMB. Epidemiological and Molecular Characteristics of HIV-1 Infection in a Sample of Men Who Have Sex With Men in Brazil: Phylogeography of Major Subtype B and F1 Transmission Clusters. Front Microbiol 2020; 11:589937. [PMID: 33329467 PMCID: PMC7732656 DOI: 10.3389/fmicb.2020.589937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022] Open
Abstract
This study describes human immunodeficiency virus 1 (HIV-1) prevalence, associated factors, viral genetic diversity, transmitted drug resistance (TDR), and acquired drug resistance mutations (DRM) among a population of 522 men who have sex with men (MSM) recruited by the respondent-driven sampling (RDS) method, in Goiânia city, the capital of the State of Goiás, Central-Western Brazil. All serum samples were tested using a four-generation enzyme-linked immunosorbent assay (ELISA), and reactive samples were confirmed by immunoblotting. Plasma RNA or proviral DNA was extracted, and partial polymerase (pol) gene including the protease/reverse transcriptase (PR/RT) region was amplified and sequenced. HIV-1 subtypes were identified by phylogenetic inference and by bootscan analysis. The time and location of the ancestral strains that originated the transmission clusters were estimated by a Bayesian phylogeographic approach. TDR and DRM were identified using the Stanford databases. Overall, HIV-1 prevalence was 17.6% (95% CI: 12.6–23.5). Self-declared black skin color, receptive anal intercourse, sex with drug user partner, and history of sexually transmitted infections were factors associated with HIV-1 infection. Of 105 HIV-1-positive samples, 78 (74.3%) were sequenced and subtyped as B (65.4%), F1 (20.5%), C (3.8%), and BF1 (10.3%). Most HIV-1 subtype B sequences (67%; 34 out of 51) branched within 12 monophyletic clusters of variable sizes, which probably arose in the State of Goiás between the 1980s and 2010s. Most subtype F1 sequences (n = 14, 88%) branched in a single monophyletic cluster that probably arose in Goiás around the late 1990s. Among 78 samples sequenced, three were from patients under antiretroviral therapy (ART); two presented DRM. Among 75 ART-naïve patients, TDR was identified in 13 (17.3%; CI 95%: 9.6–27.8). Resistance mutations to non-nucleoside reverse transcriptase inhibitors (NNRTI) predominated (14.7%), followed by nucleoside reverse transcriptase inhibitor (NRTI) mutations (5.3%) and protease inhibitor (PI) mutations (1.3%). This study shows a high prevalence of HIV-1 associated with sexual risk behaviors, high rate of TDR, and high genetic diversity driven by the local expansion of different subtype B and F1 strains. These findings can contribute to the understanding about the dissemination and epidemiological and molecular characteristics of HIV-1 among the population of MSM living away from the epicenter of epidemics in Brazil.
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Affiliation(s)
| | | | - Thaís Augusto Marinho
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | | | | | | | | | - Gonzalo Bello
- AIDS and Molecular Immunology Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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20
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Zheng M, Yu M, Cheng S, Zhou N, Ning T, Li L, Zhao F, Zhao X, Zhu J, Jiang G. Characteristics of HIV-1 molecular transmission networks and drug resistance among men who have sex with men in Tianjin, China (2014-2018). Virol J 2020; 17:169. [PMID: 33143744 PMCID: PMC7640427 DOI: 10.1186/s12985-020-01441-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/27/2020] [Indexed: 11/25/2022] Open
Abstract
Background In Tianjin, China, there is a relatively high prevalence of HIV in men who have sex with men (MSM). The number of HIV cases in Tianjin is also increasing. We investigated the HIV molecular transmission network, genetic tropisms, and drug resistance mutations in Tianjin.
Methods Blood samples were collected from 510 newly diagnosed antiretroviral therapy (ART)-naïve HIV-1-infected subjects among MSM in Tianjin. Partial pol and env genes were sequenced and used for phylogenetic, genetic tropism, and genotypic drug resistance analyses. Molecular clusters were identified with 1.5% genetic distance and 90% bootstrap support. Results Among the 436 HIV-1 pol sequences obtained from the study participants, various genotypes were identified, including CRF01_AE (56.9%), CRF07_BC (27.8%), B (7.3%), CRF55_01B (4.1%), unique recombinant forms (URFs) (3.7%), and CRF59_01B (0.2%). A higher prevalence of X4 viruses was observed in individuals infected with CRF55_01B (56.3%) and CRF01_AE (46.2%) than with other subtypes. Of all 110 sequences in the 36 clusters, 62 (56.4%) were observed in 23 CRF01_AE clusters and 18 (16.4%) in four CRF07_BC clusters. Eight sequences clustered with at least one other shared the same drug resistance mutation (DRM). In different cluster sizes, the distributions of individuals by age, presence of sexually transmitted disease, and presence of DRMs, were significantly different. Conclusion We revealed the characteristics of HIV molecular transmission, tropism, and DRMs of ART-naïve HIV-infected individuals among the MSM population in Tianjin. Identifying infected persons at risk of transmission is necessary for proposing counseling and treating these patients to reduce the risk of HIV transmission.
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Affiliation(s)
- Minna Zheng
- Department for AIDS/STD Control and Prevention, Tianjin Centers for Disease Control and Prevention, No.6 Huayue Road, Hedong District, Tianjin, 300011, China
| | - Maohe Yu
- Department for AIDS/STD Control and Prevention, Tianjin Centers for Disease Control and Prevention, No.6 Huayue Road, Hedong District, Tianjin, 300011, China
| | - Shaohui Cheng
- Department for AIDS/STD Control and Prevention, Tianjin Centers for Disease Control and Prevention, No.6 Huayue Road, Hedong District, Tianjin, 300011, China
| | - Ning Zhou
- Department for AIDS/STD Control and Prevention, Tianjin Centers for Disease Control and Prevention, No.6 Huayue Road, Hedong District, Tianjin, 300011, China
| | - Tielin Ning
- Department for AIDS/STD Control and Prevention, Tianjin Centers for Disease Control and Prevention, No.6 Huayue Road, Hedong District, Tianjin, 300011, China
| | - Long Li
- Department for AIDS/STD Control and Prevention, Tianjin Centers for Disease Control and Prevention, No.6 Huayue Road, Hedong District, Tianjin, 300011, China
| | - Fangning Zhao
- Department for AIDS/STD Control and Prevention, Tianjin Centers for Disease Control and Prevention, No.6 Huayue Road, Hedong District, Tianjin, 300011, China
| | - Xuan Zhao
- Department for AIDS/STD Control and Prevention, Tianjin Centers for Disease Control and Prevention, No.6 Huayue Road, Hedong District, Tianjin, 300011, China
| | - Jingjin Zhu
- Department for AIDS/STD Control and Prevention, Tianjin Centers for Disease Control and Prevention, No.6 Huayue Road, Hedong District, Tianjin, 300011, China
| | - Guohong Jiang
- Tianjin Centers for Disease Control and Prevention, No.6 Huayue Road, Hedong District, Tianjin, 300011, China.
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Skaathun B, Pines HA, Patterson TL, Semple SJ, Pekar J, Harvey-Vera A, Rangel G, Mehta SR. Recent HIV Infection among men who have sex with men and transgender women in Tijuana. Rev Saude Publica 2020; 54:82. [PMID: 32876301 PMCID: PMC7446761 DOI: 10.11606/s1518-8787.2020054002179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/18/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To characterize recent HIV infections among newly diagnosed men who have sex with men and transgender women in Tijuana. METHODS Limiting Antigen (LAg)-Avidity testing was performed to detect recent HIV infection within a cohort of newly-diagnosed men who have sex with men and transgender women in Tijuana. Logistic regression was used to determine characteristics associated with recent infection. A partial transmission network was inferred using HIV-1 pol sequences. Tamura-Nei 93 genetic distances were measured between all pairs of sequences, and the network was constructed by inferring putative transmission links (genetic distances ≤ 1.5%). We assessed whether recent infection was associated with clustering within the inferred network. RESULTS Recent infection was detected in 11% (22/194) of newly-diagnosed participants. Out of the participants with sequence data, 60% (9/15) with recent infection clustered compared with 31% (43/139) with chronic infection. Two recent infections belonged to the same cluster. In adjusted analyses, recent infection was associated with years of residence in Tijuana (OR = 1.5; 95%CI 1.01-1.09), cocaine use (past month) (OR = 8.50; 95%CI 1.99-28.17), and ever experiencing sexual abuse (OR = 2.85; 95%CI 1.03-7.85). DISCUSSION A total of 11% of men newly diagnosed with HIV who have sex with men and transgender women in Tijuana were recently infected. The general lack of clustering between participants with recent infection suggests continued onward HIV transmission rather than an outbreak within a particular cluster.
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Affiliation(s)
- Britt Skaathun
- University of CaliforniaDepartment of MedicineDivision of Infectious Diseases and Global Public HealthSan DiegoLa JollaUSAUniversity of California, San Diego. Department of Medicine. Division of Infectious Diseases and Global Public Health. San Diego, La Jolla, USA
| | - Heather A. Pines
- University of CaliforniaDepartment of MedicineDivision of Infectious Diseases and Global Public HealthSan DiegoLa JollaUSAUniversity of California, San Diego. Department of Medicine. Division of Infectious Diseases and Global Public Health. San Diego, La Jolla, USA
| | - Thomas L Patterson
- University of CaliforniaDepartment of PsychiatrySan DiegoLa JollaUSAUniversity of California, San Diego. Department of Psychiatry. San Diego, La Jolla, USA
| | - Shirley J Semple
- University of CaliforniaDepartment of PsychiatrySan DiegoLa JollaUSAUniversity of California, San Diego. Department of Psychiatry. San Diego, La Jolla, USA
| | - Jonathan Pekar
- University of CaliforniaBioinformatics and Systems Biology ProgramSan DiegoLa JollaUSAUniversity of California, San Diego. Bioinformatics and Systems Biology Program. San Diego, La Jolla, USA
| | - Alicia Harvey-Vera
- Universidad XochicalcoTijuanaBaja CaliforniaMexicoUniversidad Xochicalco. Tijuana, Baja California, Mexico
| | - Gudelia Rangel
- United States-Mexico Border Health CommissionTijuanaBaja CaliforniaMexicoUnited States-Mexico Border Health Commission. Tijuana, Baja California, Mexico
- El Colegio de la Frontera NorteTijuanaBaja CaliforniaMexicoEl Colegio de la Frontera Norte. Tijuana, Baja California, Mexico
| | - Sanjay R. Mehta
- University of CaliforniaDepartment of MedicineDivision of Infectious Diseases and Global Public HealthSan DiegoLa JollaUSAUniversity of California, San Diego. Department of Medicine. Division of Infectious Diseases and Global Public Health. San Diego, La Jolla, USA
- University of CaliforniaDepartment of PathologySan DiegoLa Jolla,USAUniversity of California, San Diego. Department of Pathology. San Diego, La Jolla, USA
- San Diego Veterans Affairs Medical CenterDepartment of MedicineSan DiegoUSASan Diego Veterans Affairs Medical Center. Department of Medicine. San Diego, USA
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Abstract
Previous research on respiratory infection transmission among university students has primarily focused on influenza. In this study, we explore potential transmission events for multiple respiratory pathogens in a social contact network of university students. University students residing in on-campus housing (n = 590) were followed for the development of influenza-like illness for 10-weeks during the 2012-13 influenza season. A contact network was built using weekly self-reported contacts, class schedules, and housing information. We considered a transmission event to have occurred if students were positive for the same pathogen and had a network connection within a 14-day period. Transmitters were individuals who had onset date prior to their infected social contact. Throat and nasal samples were analysed for multiple viruses by RT-PCR. Five viruses were involved in 18 transmission events (influenza A, parainfluenza virus 3, rhinovirus, coronavirus NL63, respiratory syncytial virus). Transmitters had higher numbers of co-infections (67%). Identified transmission events had contacts reported in small classes (33%), dormitory common areas (22%) and dormitory rooms (17%). These results suggest that targeting person-to-person interactions, through measures such as isolation and quarantine, could reduce transmission of respiratory infections on campus.
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Age specific evaluation of sexual behavior, STI knowledge and infection among asymptomatic adolescents and young adults. J Infect Public Health 2020; 13:1112-1117. [PMID: 32471797 DOI: 10.1016/j.jiph.2020.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/19/2020] [Accepted: 04/05/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Adolescents and young adults account for 50% of new infections with sexually transmitted infection (STI), while representing only 25% of the sexually active population. An evaluation of sexual behavior, STI knowledge and infection among youth of different age groups is relevant to formulate effective sexual health strategies. METHODS In this monocentric, open, prospective cross-sectional study, 268 asymptomatic subjects (14-30 years) were partitioned into three cohorts I: 14-19 (n=42), II: 20-25 (n=147) and III: 25-30 (n=79) years. A comparative analysis of their sexual behavior and STI knowledge was performed using a 21-item questionnaire at the WIR-Center for Sexual Health and Medicine. Prevalence of chlamydia and gonococcal infections were tested, using the Cepheid Xpert® CT/NG assay. RESULTS The three age-specific cohorts showed statistically significant differences in their relationship status, their sexual contacts and the number of life-time sexual partners. Independent of age, men who have sex with men had greater number of sexual partners across all age groups. Although >95% of participants were aware of HIV in all age groups, the corresponding awareness of non-HIV STI was consistently lower in cohort I. The awareness of trichomonas, mycoplasma and candida in particular was <50% across all agedemographies. Chlamydia screening remains poor despite current chlamydia infection among cohort I, II & III being 7.1%, 5.4%, & 11.4% respectively. CONCLUSION Our study demonstrates a demographic divide in the knowledge on most frequent STI apart from HIV. Current education, screening and vaccination programs for STI among the younger demographic should be improved.
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Dimitrov D, Wood D, Ulrich A, Swan DA, Adamson B, Lama JR, Sanchez J, Duerr A. Projected effectiveness of HIV detection during early infection and rapid ART initiation among MSM and transgender women in Peru: A modeling study. Infect Dis Model 2019; 4:73-82. [PMID: 31025025 PMCID: PMC6475714 DOI: 10.1016/j.idm.2019.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 12/01/2022] Open
Abstract
Background The Sabes study, a treatment as prevention intervention in Peru, tested the hypothesis that initiating antiretroviral therapy (ART) early in HIV infection when viral load is high, would markedly reduce onward HIV transmission among high-risk men who have sex with men (MSM) and transgender women (TW). We investigated the potential population-level benefits of detection of HIV early after acquisition and rapid initiation of ART. Methods We designed a transmission dynamic model to simulate the HIV epidemic among MSM and TW in Peru, calibrated to data on HIV prevalence and ART coverage from 2004 to 2011. We assessed the impact of an intervention starting in 2018 in which up to 50% of the new infections were diagnosed within three months of acquisition and initiated on ART within 1 month of diagnosis. We estimated the impact of the intervention over 20 years using the cumulative prevented fraction of new HIV infections compared to scenarios without intervention. Findings Our model suggests that only 19% of the infected MSM and TW are virally suppressed in 2018 and 35%-40% of the new HIV infections are transmitted from contacts with acutely-infected partners. An intervention reaching 10% of all acutely infected MSM and TW is projected to prevent 13.3% [Uncertainty interval: 11.9%-14.3%] of the new infections over 20 years and reduce HIV incidence in 2038 by 24%. Reaching 50% of all acutely infected MSM and TW will increase the prevalence of viral suppression in 2038 to 59% and prevent 41% of expected infections over 20 years. Reaching 50% of the high-risk MSM and TW in acute phase would reduce HIV incidence in 2038 by 60% and prevent 36% of new infections between 2018 and 2038. Conclusions Early detection of HIV infections and rapid initiation of ART among MSM is desirable as it would increase the effectiveness of the HIV prevention program in Peru. Targeting high-risk MSM and TW will be highly efficient.
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Affiliation(s)
- Dobromir Dimitrov
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daniel Wood
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Angela Ulrich
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - David A Swan
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Blythe Adamson
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Comparative Health Outcomes, Policy, & Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
| | - Javier R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru
| | - Jorge Sanchez
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Mayor de San Marcos, Lima, Peru
| | - Ann Duerr
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
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25
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Sexual Networks of Racially Diverse Young MSM Differ in Racial Homophily But Not Concurrency. J Acquir Immune Defic Syndr 2019; 77:459-466. [PMID: 29280767 DOI: 10.1097/qai.0000000000001620] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Substantial racial disparities exist in HIV infection among young men who have sex with men (YMSM). However, evidence suggests black YMSM do not engage in greater levels of risk behavior. Sexual networks may help explain this paradox. This study used egocentric exponential random graph models to examine variation in concurrency (ie, 2 or more simultaneous partners) and homophily (ie, same race/ethnicity partners) across race/ethnicity groups in a diverse sample of YMSM. METHODS Data for this study come from a longitudinal cohort study of YMSM. Participants (n = 1012) provided data regarding their sexual contacts during the 6 months before their first study visit. A series of egocentric exponential random graph models examined how providing separate estimates for homophily and concurrency parameters across race/ethnicity improved the fit of these models. Networks were simulated using these parameters to examine how local network characteristics impact risk at the whole network level. RESULTS Results indicated that homophily, but not concurrency, varied across race/ethnicity. Black participants witnessed significantly higher race/ethnicity homophily compared with white and Latino peers. Extrapolating from these models, black individuals were more likely to be in a connected component with an HIV-positive individual and closer to HIV-positive individuals. However, white individuals were more likely to be in large connected components. CONCLUSIONS These findings suggest that high racial homophily combined with existing disparities in HIV help perpetuate the spread of HIV among black YMSM. Nonetheless, additional work is required to understand these disparities given that homophily alone cannot sustain them indefinitely.
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Thompson RN, Wymant C, Spriggs RA, Raghwani J, Fraser C, Lythgoe KA. Link between the numbers of particles and variants founding new HIV-1 infections depends on the timing of transmission. Virus Evol 2019; 5:vey038. [PMID: 30723550 PMCID: PMC6354028 DOI: 10.1093/ve/vey038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Understanding which HIV-1 variants are most likely to be transmitted is important for vaccine design and predicting virus evolution. Since most infections are founded by single variants, it has been suggested that selection at transmission has a key role in governing which variants are transmitted. We show that the composition of the viral population within the donor at the time of transmission is also important. To support this argument, we developed a probabilistic model describing HIV-1 transmission in an untreated population, and parameterised the model using both within-host next generation sequencing data and population-level epidemiological data on heterosexual transmission. The most basic HIV-1 transmission models cannot explain simultaneously the low probability of transmission and the non-negligible proportion of infections founded by multiple variants. In our model, transmission can only occur when environmental conditions are appropriate (e.g. abrasions are present in the genital tract of the potential recipient), allowing these observations to be reconciled. As well as reproducing features of transmission in real populations, our model demonstrates that, contrary to expectation, there is not a simple link between the number of viral variants and the number of viral particles founding each new infection. These quantities depend on the timing of transmission, and infections can be founded with small numbers of variants yet large numbers of particles. Including selection, or a bias towards early transmission (e.g. due to treatment), acts to enhance this conclusion. In addition, we find that infections initiated by multiple variants are most likely to have derived from donors with intermediate set-point viral loads, and not from individuals with high set-point viral loads as might be expected. We therefore emphasise the importance of considering viral diversity in donors, and the timings of transmissions, when trying to discern the complex factors governing single or multiple variant transmission.
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Affiliation(s)
- Robin N Thompson
- Department of Zoology, University of Oxford, South Parks Road, Oxford, UK.,Mathematical Institute, University of Oxford, Andrew Wiles Building, Radcliffe Observatory Quarter, Oxford, UK.,Christ Church, University of Oxford, St Aldates, Oxford, UK
| | - Chris Wymant
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rebecca A Spriggs
- Department of Plant Sciences, University of Cambridge, Downing Street, Cambridge, UK
| | - Jayna Raghwani
- Department of Zoology, University of Oxford, South Parks Road, Oxford, UK.,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christophe Fraser
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Katrina A Lythgoe
- Department of Zoology, University of Oxford, South Parks Road, Oxford, UK.,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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27
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Goodreau SM, Stansfield SE, Murphy JT, Peebles KC, Gottlieb GS, Abernethy NF, Herbeck JT, Mittler JE. Relational concurrency, stages of infection, and the evolution of HIV set point viral load. Virus Evol 2018; 4:vey032. [PMID: 30483403 PMCID: PMC6249390 DOI: 10.1093/ve/vey032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
HIV viral load (VL) predicts both transmission potential and rate of disease progression. For reasons that are still not fully understood, the set point viral load (SPVL) established after acute infection varies across individuals and populations. Previous studies have suggested that population mean SPVL (MSPVL) has evolved near an optimum that reflects a trade-off between transmissibility and host survival. Sexual network structures affect rates of potential exposure during different within-host phases of infection marked by different transmission probabilities, and thus affect the number and timing of transmission events. These structures include relational concurrency, which has been argued to explain key differences in HIV burden across populations. We hypothesize that concurrency will alter the fitness landscape for SPVL in ways that differ from other network features whose impacts accrue at other times during infection. To quantitatively test this hypothesis, we developed a dynamic, stochastic, data-driven network model of HIV transmission, and evolution to assess the impact of key sexual network phenomena on MSPVL evolution. Experiments were repeated in sensitivity runs that made different assumptions about transmissibility during acute infection, SPVL heritability, and the functional form of the relationship between VL and transmissibility. For our main transmission model, scenarios yielded MSPVLs ranging from 4.4 to 4.75 log10 copies/ml, covering much of the observed empirical range. MSPVL evolved to be higher in populations with high concurrency and shorter relational durations, with values varying over a clinically significant range. In linear regression analyses on these and other predictors, main effects were significant (P < 0.05), as were interaction terms, indicating that effects are interdependent. We also noted a strong correlation between two key emergent properties measured at the end of the simulations-MSPVL and HIV prevalence-most clearly for phenomena that affect transmission networks early in infection. Controlling for prevalence, high concurrency yielded higher MSPVL than other network phenomena. Interestingly, we observed lower prevalence in runs in which SPVL heritability was zero, indicating the potential for viral evolution to exacerbate disease burden over time. Future efforts to understand empirical variation in MSPVL should consider local HIV burden and basic sexual behavioral and network structure.
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Affiliation(s)
- Steven M Goodreau
- Department of Anthropology, Campus Box 353100, Seattle, WA 98195, USA
| | | | - James T Murphy
- Department of Microbiology, Campus Box 357735, Seattle, WA 98195, USA
| | - Kathryn C Peebles
- Department of Epidemiology, Campus Box 357236, Seattle, WA 98195, USA
| | - Geoffrey S Gottlieb
- Departments of Medicine and Global Health, Campus Box 356420, Seattle, WA 98195, USA
| | - Neil F Abernethy
- Department of Biomedical Informatics and Medical Education, Campus Box 358047, Seattle, WA 98195, USA
| | - Joshua T Herbeck
- Department of Global Health, University of Washington, Campus Box 353100, Seattle, WA 98195, USA
| | - John E Mittler
- Department of Microbiology, Campus Box 357735, Seattle, WA 98195, USA
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Le Vu S, Ratmann O, Delpech V, Brown AE, Gill ON, Tostevin A, Fraser C, Volz EM. Comparison of cluster-based and source-attribution methods for estimating transmission risk using large HIV sequence databases. Epidemics 2017; 23:1-10. [PMID: 29089285 DOI: 10.1016/j.epidem.2017.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/12/2017] [Accepted: 10/17/2017] [Indexed: 11/26/2022] Open
Abstract
Phylogenetic clustering of HIV sequences from a random sample of patients can reveal epidemiological transmission patterns, but interpretation is hampered by limited theoretical support and statistical properties of clustering analysis remain poorly understood. Alternatively, source attribution methods allow fitting of HIV transmission models and thereby quantify aspects of disease transmission. A simulation study was conducted to assess error rates of clustering methods for detecting transmission risk factors. We modeled HIV epidemics among men having sex with men and generated phylogenies comparable to those that can be obtained from HIV surveillance data in the UK. Clustering and source attribution approaches were applied to evaluate their ability to identify patient attributes as transmission risk factors. We find that commonly used methods show a misleading association between cluster size or odds of clustering and covariates that are correlated with time since infection, regardless of their influence on transmission. Clustering methods usually have higher error rates and lower sensitivity than source attribution method for identifying transmission risk factors. But neither methods provide robust estimates of transmission risk ratios. Source attribution method can alleviate drawbacks from phylogenetic clustering but formal population genetic modeling may be required to estimate quantitative transmission risk factors.
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Affiliation(s)
- Stéphane Le Vu
- Department of Infectious Disease Epidemiology and the NIHR HPRU on Modeling Methodology, Imperial College London, United Kingdom.
| | - Oliver Ratmann
- Department of Mathematics, Imperial College London, United Kingdom
| | - Valerie Delpech
- HIV and STI Department of Public Health England's Centre for Infectious Disease Surveillance and Control, London, United Kingdom
| | - Alison E Brown
- HIV and STI Department of Public Health England's Centre for Infectious Disease Surveillance and Control, London, United Kingdom
| | - O Noel Gill
- HIV and STI Department of Public Health England's Centre for Infectious Disease Surveillance and Control, London, United Kingdom
| | - Anna Tostevin
- Department of Infection and Population Health and the NIHR HPRU in Blood Borne and Sexually Transmitted Infections, University College London, United Kingdom
| | - Christophe Fraser
- Li Ka Shing Centre for Health Information and Discovery, Oxford University, United Kingdom
| | - Erik M Volz
- Department of Infectious Disease Epidemiology and the NIHR HPRU on Modeling Methodology, Imperial College London, United Kingdom
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Pines HA, Karris MY, Little SJ. Sexual Partner Concurrency Among Partners Reported by MSM with Recent HIV Infection. AIDS Behav 2017; 21:3026-3034. [PMID: 28702851 PMCID: PMC5983362 DOI: 10.1007/s10461-017-1855-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We examined concurrency among sexual partners reported by men who have sex with men (MSM) with recent (acute or early) HIV infection in San Diego, California (2002-2015). Partners overlapping in time in the past 3 months were considered concurrent. Logistic generalized linear mixed models were used to identify factors associated with concurrency at the partner-level. 56% (388/699) of partners were concurrent to ≥1 other partner. The odds of concurrency were higher among partners >10 years younger than the participant (vs. within 10 years of age) [adjusted odds ratio (AOR) = 2.22, 95% confidence interval (CI) 1.09-4.52], longer term partners (AOR per month = 1.02, 95% CI 1.01-1.03), and partners met online (AOR = 1.56, 95% CI 0.98-2.48). Concurrency is common among partners of recently HIV-infected MSM. Tailored HIV prevention strategies for MSM with older partners, longer term partners, and partners met online may help minimize the potential impact of concurrency on HIV transmission.
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Affiliation(s)
- Heather A Pines
- Department of Medicine, University of California, San Diego, 9500 Gilman Dr, MC 0507, La Jolla, CA, 92093-0507, USA.
| | - Maile Y Karris
- Department of Medicine, University of California, San Diego, 9500 Gilman Dr, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Susan J Little
- Department of Medicine, University of California, San Diego, 9500 Gilman Dr, MC 0507, La Jolla, CA, 92093-0507, USA
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