Phylodynamic Analysis Complements Partner Services by Identifying Acute and Unreported HIV Transmission
Phylodynamic Analysis Complements Partner Services by Identifying Acute and Unreported HIV Transmission
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DOI：
10.3390/v12020145
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发表时间：
2020-02-01
期刊：
影响因子：
4.7
通讯作者：
Peters, Philip J.
中科院分区：
文献类型：
--
作者：
Campbell, Ellsworth M.;Patala, Anne;Peters, Philip J.
针对日益增长的艾滋病毒传播集群调整公共卫生应对措施，取决于准确绘制传播艾滋病毒的风险网络图，并确定代表集群增长前沿的急性感染。艾滋病毒传播联系，特别是涉及急性艾滋病毒感染者的传播联系，在伙伴服务调查期间可能很难发现或确认。我们整合了分子、流行病学、血清学和行为数据，以推断和评估2011-2013年在北卡罗来纳州、纽约市和旧金山进行的一项AHI前瞻性研究参与者之间的传播联系。在547名新诊断为HIV聚合酶序列的参与者中，报告了465名性伴，其中只有35人(7.5%)具有HIV序列。在这35名接触者中，有23人(65.7%)有遗传支持，12人(34.3%)没有遗传支持。据报道，患有AHI的参与者之间只有5个联系，但没有一个是遗传支持的。相比之下，系统动力学推断确定了102条未报告的传播链路，其中包括12条AHI患者之间的传播链路。重要的是，所有假定的AHI患者之间的传播联系都是在有五个以上成员的大型聚集性中发现的。综上所述，急性参与者之间存在假定的联系，这些参与者彼此没有点名，只是在大型集群中才能找到联系，这突显了未被观察到或未被诊断出的中间人的可能性。系统动力学发现了比合作伙伴服务本身多得多的联系，如果定期和快速地整合，可以阐明合作伙伴服务调查不易捕捉到的传播模式。
Tailoring public health responses to growing HIV transmission clusters depends on accurately mapping the risk network through which it spreads and identifying acute infections that represent the leading edge of cluster growth. HIV transmission links, especially those involving persons with acute HIV infection (AHI), can be difficult to uncover, or confirm during partner services investigations. We integrated molecular, epidemiologic, serologic and behavioral data to infer and evaluate transmission linkages between participants of a prospective study of AHI conducted in North Carolina, New York City and San Francisco from 2011-2013. Among the 547 participants with newly diagnosed HIV with polymerase sequences, 465 sex partners were reported, of whom only 35 (7.5%) had HIV sequences. Among these 35 contacts, 23 (65.7%) links were genetically supported and 12 (34.3%) were not. Only five links were reported between participants with AHI but none were genetically supported. In contrast, phylodynamic inference identified 102 unreported transmission links, including 12 between persons with AHI. Importantly, all putative transmission links between persons with AHI were found among large clusters with more than five members. Taken together, the presence of putative links between acute participants who did not name each other as contacts that are found only among large clusters underscores the potential for unobserved or undiagnosed intermediaries. Phylodynamics identified many more links than partner services alone and, if routinely and rapidly integrated, can illuminate transmission patterns not readily captured by partner services investigations.