Characterizing HIV Transmission Networks Across the United States
Characterizing HIV Transmission Networks Across the United States
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DOI：
10.1093/cid/cis612
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发表时间：
2012-10-15
影响因子：
11.8
通讯作者：
Smith, Davey M.
中科院分区：
文献类型：
--
作者：
Aldous, Jeannette L.;Pond, Sergei Kosakovsky;Smith, Davey M.
背景临床上，人类免疫缺陷病毒1型（HIV-1）pol序列用于评估耐药性。这些数据也可用于评估传输网络，并帮助描述与传输风险相关的因素。对2000-2009年CFAR综合临床系统网络（CNICS）队列中5个地点的参与者的HIV-1 pol序列进行了遗传相关性分析。仅包括每位参与者的第一个可用序列。推断的传播网络（“簇”）被定义为≥ 2个序列，≥ 3个患者（“网络”）被评估临床和人口统计学关联。在3697个序列中，24%落入推断的簇中：155个2个个体的簇（“二对”），54个包括3-14个个体的簇（“网络”），以及1个包括所有研究地点的336个个体的大簇。在多变量分析中，与聚类相关的因素包括在采样时未使用抗逆转录病毒（ARV）药物（P < .001），2004年后收集的序列（P < .001），CD 4细胞计数>350个细胞/mL（P < .01），和病毒载量10 000-100 000拷贝/mL（P < .001）或>100 000拷贝/mL（P < .001）。在网络中，女性更容易与其他女性聚集（P < .001），非洲裔美国人与其他非洲裔美国人聚集（P < .001）。分子流行病学可用于研究地理和人口统计学上不同的人群中的HIV传播网络。聚集与缺乏抗逆转录病毒药物使用和较高的病毒载量有关，这意味着早期诊断和治疗可能会中断传播。观察到的女性和非裔美国人网络强调了按性别和种族进行诊断和预防工作的重要性。
Background. Clinically, human immunodeficiency virus type 1 (HIV-1) pol sequences are used to evaluate for drug resistance. These data can also be used to evaluate transmission networks and help describe factors associated with transmission risk.Methods. HIV-1 pol sequences from participants at 5 sites in the CFAR Network of Integrated Clinical Systems (CNICS) cohort from 2000-2009 were analyzed for genetic relatedness. Only the first available sequence per participant was included. Inferred transmission networks ("clusters") were defined as >= 2 sequences with = 3 patients ("networks") were evaluated for clinical and demographic associations.Results. Of 3697 sequences, 24% fell into inferred clusters: 155 clusters of 2 individuals ("dyads"), 54 clusters that included 3-14 individuals ("networks"), and 1 large cluster that included 336 individuals across all study sites. In multivariable analyses, factors associated with being in a cluster included not using antiretroviral (ARV) drugs at time of sampling (P < .001), sequence collected after 2004 (P < .001), CD4 cell count >350 cells/mL (P < .01), and viral load 10 000-100 000 copies/mL (P < .001) or >100 000 copies/mL (P < .001). In networks, women were more likely to cluster with other women (P < .001), and African Americans with other African Americans (P < .001).Conclusions. Molecular epidemiology can be applied to study HIV transmission networks in geographically and demographically diverse cohorts. Clustering was associated with lack of ARV use and higher viral load, implying transmission may be interrupted by earlier diagnosis and treatment. Observed female and African American networks reinforce the importance of diagnosis and prevention efforts targeted by sex and race.