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Insights into HIV-1 Transmission Dynamics Using Routinely Collected Data in the Mid-Atlantic United States. Viruses Kassaye, S. G., Grossman, Z., Vengurlekar, P., Chai, W., Wallace, M., Rhee, S. Y., Meyer, W. A., Kaufman, H. W., Castel, A., Jordan, J., Crandall, K. A., Kang, A., Kumar, P., Katzenstein, D. A., Shafer, R. W., Maldarelli, F. 2022; 15 (1)

Abstract

Molecular epidemiological approaches provide opportunities to characterize HIV transmission dynamics. We analyzed HIV sequences and virus load (VL) results obtained during routine clinical care, and individual's zip-code location to determine utility of this approach.HIV-1 pol sequences aligned using ClustalW were subtyped using REGA. A maximum likelihood (ML) tree was generated using IQTree. Transmission clusters with =3% genetic distance (GD) and =90% bootstrap support were identified using ClusterPicker. We conducted Bayesian analysis using BEAST to confirm transmission clusters. The proportion of nucleotides with ambiguity =0.5% was considered indicative of early infection. Descriptive statistics were applied to characterize clusters and group comparisons were performed using chi-square or t-test.Among 2775 adults with data from 2014-2015, 2589 (93%) had subtype B HIV-1, mean age was 44 years (SD 12.7), 66.4% were male, and 25% had nucleotide ambiguity =0.5. There were 456 individuals in 193 clusters: 149 dyads, 32 triads, and 12 groups with = four individuals per cluster. More commonly in clusters were males than females, 349 (76.5%) vs. 107 (23.5%), p < 0.0001; younger individuals, 35.3 years (SD 12.1) vs. 44.7 (SD 12.3), p < 0.0001; and those with early HIV-1 infection by nucleotide ambiguity, 202/456 (44.3%) vs. 442/2133 (20.7%), p < 0.0001. Members of 43/193 (22.3%) of clusters included individuals in different jurisdictions. Clusters = four individuals were similarly found using BEAST. HIV-1 viral load (VL) =3.0 log10 c/mL was most common among individuals in clusters = four, 18/21, (85.7%) compared to 137/208 (65.8%) in clusters sized 2-3, and 927/1169 (79.3%) who were not in a cluster (p < 0.0001).HIV sequence data obtained for HIV clinical management provide insights into regional transmission dynamics. Our findings demonstrate the additional utility of HIV-1 VL data in combination with phylogenetic inferences as an enhanced contact tracing tool to direct HIV treatment and prevention services. Trans-jurisdictional approaches are needed to optimize efforts to end the HIV epidemic.

View details for DOI 10.3390/v15010068

View details for PubMedID 36680108