Targeting HIV Prevention Based on Molecular Epidemiology Among Deeply Sampled Subnetworks of Men Who Have Sex With Men
Open Access
- 30 June 2015
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 61 (9), 1462-1468
- https://doi.org/10.1093/cid/civ526
Abstract
Background. Molecular epidemiology can be useful in identifying clusters of human immunodeficiency virus (HIV) transmission that can be targeted for prevention. Methods. Regular screening of 2000 men who have sex with men (MSM) in Beijing, China, for HIV infection every 2 months identified 179 primary infections (2007–2010). HIV-1 pol sequences were obtained and used to infer the transmission network and identify transmitted drug resistance (TDR) among these individuals. We evaluated the use of clinical and network information to target prevention efforts. Prevention efficiency was calculated as the number of infections saved per number of interventions. Results. This cohort was infected with HIV-1 subtype B (28%), circulating recombinant form (CRF)_01 AE (53%), and CRF_07 BC (16%). The overall rate of TDR was low (5%), but the rate of clustering was high (64%), suggesting deep sampling of the subnetwork. Provision of a theoretically high-efficacy intervention like antiretroviral therapy to all participants had a prevention efficiency of 23%. The efficiency of targeting prevention based on lower CD4 counts (50 000 copies/mL) was between 10% and 18%. The efficiency of targeting prevention based on number of network connections was much higher (30%–42%). For example, treating the 33 participants with ≥5 connections in 2009 would have theoretically prevented 14 infections in 2010 (42% prevention efficiency). Conclusions. Regular HIV testing of MSM in Beijing can deeply sample the local transmission subnetwork, and targeting prevention efforts based on network connectivity may be an efficient way to deliver prevention interventions.Keywords
Funding Information
- China Scholarship Council and Beijing Key Laboratory (BZ0089)
- Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (ZY201401)
- Project of Beijing Municipal Science and Technology Commission (D141100000314005, D141100000314002)
- Key Project of the National Twelfth-Five Year Research Program of China (2012ZX10001-003, 2012ZX10001-006)
- The Department of Veterans Affairs
- National Institutes of Health (AI100665, DA034978, MH083552, AI036214, MH062512, K01AI110181, AI093163, MH100974, AI108351))
- The James B. Pendleton Charitable Trust
This publication has 38 references indexed in Scilit:
- Inconsistencies in Estimating the Age of HIV-1 Subtypes Due to HeterotachyMolecular Biology and Evolution, 2011
- Viral phylodynamics and the search for an ‘effective number of infections’Philosophical Transactions Of The Royal Society B-Biological Sciences, 2010
- A public health model for the molecular surveillance of HIV transmission in San Diego, CaliforniaAIDS, 2009
- High Rates of Forward Transmission Events after Acute/Early HIV‐1 InfectionThe Journal of Infectious Diseases, 2007
- Natural polymorphism in protease and reverse transcriptase genes and in vitro antiretroviral drug susceptibilities of non-B HIV-1 strains from treatment-naive patientsJournal of Clinical Virology, 2006
- Genetic analysis reveals the complex structure of HIV-1 transmission within defined risk groupsProceedings of the National Academy of Sciences of the United States of America, 2005
- HyPhy: hypothesis testing using phylogeniesBioinformatics, 2004
- Scale-Free Networks and Sexually Transmitted DiseasesSexually Transmitted Diseases, 2004
- Detecting hypermutations in viral sequences with an emphasis on G → A hypermutationBioinformatics, 2000
- Estimation of the number of nucleotide substitutions in the control region of mitochondrial DNA in humans and chimpanzees.Molecular Biology and Evolution, 1993