Phylogenetic insights into regional HIV transmission.
Phylogenetic insights into regional HIV transmission.
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DOI：
10.1097/qad.0b013e3283573244
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发表时间：
2012-09-10
期刊：
影响因子：
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通讯作者：
Eron JJ
中科院分区：
文献类型：
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作者：
Dennis AM;Hué S;Hurt CB;Napravnik S;Sebastian J;Pillay D;Eron JJ
尽管采取了预防措施，但在美国南部，新的艾滋病毒诊断仍在继续，在那里，这种流行病的特点是明显的种族/民族差异。我们将系统发育分析与临床数据相结合，以揭示当地HIV传播的趋势。在慢性（82%；UNC艾滋病研究中心临床队列）或急性/近期（18%；杜克大学/UNC急性HIV联盟）感染期间，对1671名HIV感染者进行了横截面分析，每个人都有一个b亚型pol序列。采用邻域连接法进行系统发育推断，选择相关序列，并用贝叶斯方法进行系统发育确认。我们通过种族/民族和传播风险等因素来描述传播集群（≥3个序列的进化支，后验概率=1）。对新诊断的患者进行与聚类隶属度相关的因素评估。总体而言，72%是男性，59%是黑人，39%是男男性行为者。共有557个（33%）序列分成108对（n=216）或67个簇（n=341）。集群范围从3-36（中位数4）个成员。构成主要是由种族划分的，28%是黑人，其次是风险组。男男性行为者和异性恋者形成了离散的群体，尽管观察到大量的混合。在多变量分析中，年龄≤30岁（P=0.009）、急性感染（P=0.02）、本地居住（P=0.002）和传播性耐药（P=0.02）的患者更容易成为聚类成员，拉美裔患者的可能性更低（P<0.001）。分子、临床和人口统计数据的整合为局部传播网络的结构提供了一个独特的视角。黑人种族、青年和TDR的聚类以及无法识别拉丁裔聚类将为预防、检测和与护理策略的联系提供信息。
Despite prevention efforts new HIV diagnoses continue in the Southern US, where the epidemic is characterized by significant racial/ethnic disparities. We integrated phylogenetic analyses with clinical data to reveal trends in local HIV transmission. Cross-sectional analysis of 1671 HIV-infected individuals each with one B-subtype pol sequence obtained during chronic (82%; UNC Center for AIDS Research Clinical Cohort) or acute/recent (18%; Duke/UNC Acute HIV Consortium) infection. Phylogenies were inferred using neighbor joining to select related sequences then confirmed with Bayesian methods. We characterized transmission clusters (clades n≥3 sequences supported by posterior probabilities=1) by factors including race/ethnicity and transmission risk. Factors associated with cluster membership were evaluated for newly diagnosed patients. Overall, 72% were male, 59% black and 39% MSM. A total of 557 (33%) sequences grouped in either 108 pairs (n=216) or 67 clusters (n=341). Clusters ranged from 3–36 (median 4) members. Composition was delineated primarily by race, with 28% exclusively black, and to a lesser extent by risk group. Both MSM and heterosexuals formed discrete clusters though substantial mixing was observed. In multivariable analysis, patients with age ≤30 years (P=0.009), acute infection (P=0.02), local residence (P=0.002), and transmitted drug resistance (P=0.02) were more likely to be cluster members while Latinos were less likely (P<0.001). Integration of molecular, clinical and demographic data offers a unique view into the structure of local transmission networks. Clustering by black race, youth and TDR and inability to identify Latino clusters will inform prevention, testing and linkage to care strategies.