Rising prevalence of non-B HIV-1 subtypes in North Carolina and evidence for local onward transmission.
Rising prevalence of non-B HIV-1 subtypes in North Carolina and evidence for local onward transmission.
复制标题
DOI：
10.1093/ve/vex013
复制
发表时间：
2017-01
期刊：
影响因子：
5.3
通讯作者：
Eron JJ
中科院分区：
文献类型：
--
作者：
Dennis AM;Hué S;Learner E;Sebastian J;Miller WC;Eron JJ
在北美和欧洲的人群中，HIV-1的多样性正在增加，这可能会对公共卫生产生影响。然而，对美国南部的非B亚型多样性知之甚少，尽管该地区是美国流行病的中心。我们的特点是HIV-1的多样性和传播集群，以确定在何种程度上非B株在当地传播。我们对1997年至2014年从北卡罗来纳州（NC）接受常规临床护理的成人中收集的HIV-1部分pol序列进行了横断面分析。使用COMET和系统发育分析评估亚型。使用最大似然树确定推定的传播集群。涉及非B菌株的集群得到确认，并使用贝叶斯遗传学估计其起源日期。数据与样本采集时收集的人口统计学信息和患者子集的原籍国相结合。在来自15，246人的24，972个序列中，非B亚型患病率在研究期间从0%增加到3.46%。在325名非B亚型患者中，纯亚型和重组亚型的多样性较高，超过15种; C亚型（28.9%）和CRF02_AG（24.0%）最常见。虽然非B亚型人群的传播聚集性低于B亚型人群，但发现了几个涉及非B亚型的局部传播聚集性（≥3人），推测所有传播均由异性传播所致。NC中非B亚型多样性的患病率仍然较低，但随着时间的推移，发现了统计学显著性上升，这可能反映了多重输入。然而，结合系统发育聚类分析揭示了当地向前传播的证据。检测到这些非B群表明异性性传播，并可能指导诊断和预防干预措施。
HIV-1 diversity is increasing in North American and European cohorts which may have public health implications. However, little is known about non-B subtype diversity in the southern United States, despite the region being the epicenter of the nation’s epidemic. We characterized HIV-1 diversity and transmission clusters to identify the extent to which non-B strains are transmitted locally. We conducted cross-sectional analyses of HIV-1 partial pol sequences collected from 1997 to 2014 from adults accessing routine clinical care in North Carolina (NC). Subtypes were evaluated using COMET and phylogenetic analysis. Putative transmission clusters were identified using maximum-likelihood trees. Clusters involving non-B strains were confirmed and their dates of origin were estimated using Bayesian phylogenetics. Data were combined with demographic information collected at the time of sample collection and country of origin for a subset of patients. Among 24,972 sequences from 15,246 persons, the non-B subtype prevalence increased from 0% to 3.46% over the study period. Of 325 persons with non-B subtypes, diversity was high with over 15 pure subtypes and recombinants; subtype C (28.9%) and CRF02_AG (24.0%) were most common. While identification of transmission clusters was lower for persons with non-B versus B subtypes, several local transmission clusters (≥3 persons) involving non-B subtypes were identified and all were presumably due to heterosexual transmission. Prevalence of non-B subtype diversity remains low in NC but a statistically significant rise was identified over time which likely reflects multiple importation. However, the combined phylogenetic clustering analysis reveals evidence for local onward transmission. Detection of these non-B clusters suggests heterosexual transmission and may guide diagnostic and prevention interventions.