Detailed Transmission Network Analysis of a Large Opiate-Driven Outbreak of HIV Infection In the United States
Detailed Transmission Network Analysis of a Large Opiate-Driven Outbreak of HIV Infection In the United States
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DOI：
10.1093/infdis/jix307
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发表时间：
2017-11-01
影响因子：
6.4
通讯作者：
Switzer, William M.
中科院分区：
文献类型：
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作者：
Campbell, Ellsworth M.;Jia, Hongwei;Switzer, William M.
2015年1月，印第安纳州农村发现注射吸毒者(PWID)中爆发了未诊断的人类免疫缺陷病毒(HIV)感染。截至2016年9月，在这个约有4400人的社区中，已有205人被诊断为艾滋病毒感染。我们报告了分析流行病学和实验室数据以了解此次暴发期间传播的新方法的结果。使用聚合酶区域计算HIV的遗传距离。使用有关报告的高危接触者、病毒遗传相似性及其最简约组合的数据生成网络。样本采集日期和新近检测结果被用来推断感染日期。流行病学和实验室数据各自形成了庞大而密集的网络。整合这些数据揭示了具有流行病学和遗传共性的亚组，其中一组似乎包含最早的感染。预测的感染日期表明，传播始于2011年，在2014年年中经历了爆炸性增长，并在宣布公共卫生紧急状态后放缓。这一系统动力学分析的结果表明，大多数感染很可能在调查开始时就已经发生，早期传播可能与性行为和注射药物使用有关。需要作出早期和持续的努力，以发现感染并防止或阻断未感染的PWID网络内的快速传播。
In January 2015, an outbreak of undiagnosed human immunodeficiency virus (HIV) infections among persons who inject drugs (PWID) was recognized in rural Indiana. By September 2016, 205 persons in this community of approximately 4400 had received a diagnosis of HIV infection. We report results of new approaches to analyzing epidemiologic and laboratory data to understand transmission during this outbreak. HIV genetic distances were calculated using the polymerase region. Networks were generated using data about reported high-risk contacts, viral genetic similarity, and their most parsimonious combinations. Sample collection dates and recency assay results were used to infer dates of infection. Epidemiologic and laboratory data each generated large and dense networks. Integration of these data revealed subgroups with epidemiologic and genetic commonalities, one of which appeared to contain the earliest infections. Predicted infection dates suggest that transmission began in 2011, underwent explosive growth in mid-2014, and slowed after the declaration of a public health emergency. Results from this phylodynamic analysis suggest that the majority of infections had likely already occurred when the investigation began and that early transmission may have been associated with sexual activity and injection drug use. Early and sustained efforts are needed to detect infections and prevent or interrupt rapid transmission within networks of uninfected PWID.