Phylogenetic Cluster Analysis Identifies Virological and Behavioral Drivers of HIV Transmission in MSM.

Bachmann, Nadine; Kusejko, Katharina; Nguyen, Huyen; Chaudron, Sandra E; Kadelka, Claus; Turk, Teja; Böni, Jürg; Perreau, Matthieu; Klimkait, Thomas; Yerly, Sabine; Battegay, Manuel; Rauch, Andri; Ramette, Alban; Vernazza, Pietro; Bernasconi, Enos; Cavassini, Matthias; Günthard, Huldrych F; Kouyos, Roger D (2020). Phylogenetic Cluster Analysis Identifies Virological and Behavioral Drivers of HIV Transmission in MSM. (In Press). Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Oxford University Press 10.1093/cid/ciaa411

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BACKGROUND Identifying local outbreaks and their drivers is a key step towards curbing HIV transmission and potentially achieving HIV elimination. Such outbreaks can be identified as transmission clusters extracted from phylogenetic trees constructed of densely sampled viral sequences. In this study, we combined phylogenetic transmission clusters with extensive data on virological suppression and behavioral risk of cluster members to quantify the drivers of ongoing transmission over ten years. METHODS Using the comprehensive Swiss HIV Cohort Study and its drug-resistance database, we reconstructed phylogenetic trees for each year between 2007-2017. We identified HIV transmission clusters dominated by men who have sex with men(MSM) and determined their annual growth. We used Poisson regression to assess if cluster-growth was associated with a per-cluster-infectivity and behavioral-risk score. RESULTS Both infectivity and behavioral risk scores were significantly higher in growing MSM transmission clusters compared to non-growing clusters (p≤0.01). The fraction of transmission clusters without infectious members acquiring new infections increased significantly over the study period. The infectivity score was significantly associated with per-capita incidence of MSM transmission clusters in eight years, while the behavioral risk score was significantly associated with per-capita incidence of MSM transmission clusters in three years. CONCLUSIONS We present a phylogenetic method to identify hotspots of ongoing transmission among MSM. Our results demonstrate the effectiveness of treatment as prevention at the population level. However, the significantly increasing number of new infections among transmission clusters without infectious members highlight a relative shift from diagnosed to undiagnosed individuals as drivers of HIV transmission in Swiss MSM.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Rauch, Andri and Ramette, Alban Nicolas

Subjects:

500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health

ISSN:

1537-6591

Publisher:

Oxford University Press

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

13 May 2020 08:24

Last Modified:

13 May 2020 08:24

Publisher DOI:

10.1093/cid/ciaa411

PubMed ID:

32300807

Uncontrolled Keywords:

HIV transmission clusters MSM Phylogenetics drivers of transmission

BORIS DOI:

10.7892/boris.143479

URI:

https://boris.unibe.ch/id/eprint/143479

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