HIV-1 Transmission Clustering and Phylodynamics Highlight the Important Role of Young Men Who Have Sex with Men.
HIV-1 Transmission Clustering and Phylodynamics Highlight the Important Role of Young Men Who Have Sex with Men.
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DOI：
10.1089/aid.2018.0039
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发表时间：
2018-10
影响因子：
1.5
通讯作者：
Kalish ML
中科院分区：
文献类型：
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作者：
Dennis AM;Volz E;Frost ASMSDW;Hossain M;Poon AFY;Rebeiro PF;Vermund SH;Sterling TR;Kalish ML
居住在美国南部的艾滋病毒感染者比其他任何地区都多，但对南部的艾滋病毒分子流行病学知之甚少。我们使用聚类和聚类动态分析来评估田纳西州中部的艾滋病毒传播模式。我们对2001年至2015年在范德比尔特综合护理诊所就诊的人中收集的HIV-1 pol序列和临床数据进行了横断面分析。传播集群确定使用最大似然遗传学和教父距离差异。评估了人口统计学、风险行为和临床因素，评价了“活跃”聚类（聚类包括2011-2015年采样的序列），并使用逻辑回归估计了相关性。用双动力学模型估计男男性行为者（MSM）的传播风险比。在2915人（96%的B亚型序列）中，963人（33%）属于292个簇（距离≤ 1.5%，大小范围2-39）。大多数集群（62%，n = 690人）是活跃的，无论是新发现的（n = 80）或现有集群的扩展（n = 101）。在2011-2015年期间收集的序列中，活跃聚集的相关因素包括MSM风险和≤30岁。活跃的集群显着更集中在男男性接触者和年轻人比历史集群。年轻MSM（≤26.4岁）的估计传播风险较高[相对于年长MSM的风险比= 4.04（2.85-5.65）]，更有可能传播给YMSM。在这个田纳西州的队列中，随着时间的推移，传播集群更集中于男男性行为者和年轻人，YMSM之间的传播风险很高，这突出了在这一群体中干预的重要性。检测活跃的集群可以帮助直接干预，破坏正在进行的传播链。
More persons living with HIV reside in the Southern United States than in any other region, yet little is known about HIV molecular epidemiology in the South. We used cluster and phylodynamic analyses to evaluate HIV transmission patterns in middle Tennessee. We performed cross-sectional analyses of HIV-1 pol sequences and clinical data collected from 2001 to 2015 among persons attending the Vanderbilt Comprehensive Care Clinic. Transmission clusters were identified using maximum likelihood phylogenetics and patristic distance differences. Demographic, risk behavior, and clinical factors were assessed evaluating “active” clusters (clusters including sequences sampled 2011–2015) and associations estimated with logistic regression. Transmission risk ratios for men who have sex with men (MSM) were estimated with phylodynamic models. Among 2915 persons (96% subtype-B sequences), 963 (33%) were members of 292 clusters (distance ≤1.5%, size range 2–39). Most clusters (62%, n = 690 persons) were active, either being newly identified (n = 80) or showing expansion on existing clusters (n = 101). Correlates of active clustering among persons with sequences collected during 2011–2015 included MSM risk and ≤30 years of age. Active clusters were significantly more concentrated in MSM and younger persons than historical clusters. Young MSM (YMSM) (≤26.4 years) had high estimated transmission risk [risk ratio = 4.04 (2.85–5.65) relative to older MSM] and were much more likely to transmit to YMSM. In this Tennessee cohort, transmission clusters over time were more concentrated by MSM and younger age, with high transmission risk among and between YMSM, highlighting the importance of interventions among this group. Detecting active clusters could help direct interventions to disrupt ongoing transmission chains.