Geographic Distribution of HIV Transmission Networks in the United States

Abstract

Background: Understanding geographic patterns of HIV transmission is critical to designing effective interventions. We characterized geographic proximity by transmission risk and urban–rural characteristics among people with closely related HIV strains suggestive of potential transmission relationships. Methods: We analyzed US National HIV Surveillance System data of people diagnosed between 2010 and 2016 with a reported HIV-1 partial polymerase nucleotide sequence. We used HIV TRAnsmission Cluster Engine (HIV-TRACE) to identify sequences linked at a genetic distance of ≤0.5%. For each linked person, we assessed median distances between counties of residence at diagnosis by transmission category and urban–rural classification, weighting observations to account for persons with multiple linked sequences. Results: There were 24,743 persons with viral sequence linkages to at least one other person included in this analysis. Overall, half (50.9%) of persons with linked viral sequences resided in different counties, and the median distance from persons with linked viruses was 11 km/7 miles [interquartile range (IQR), 0–145 km/90 miles]. Median distances were highest for men who have sex with men (MSM: 14 km/9 miles; IQR, 0–179 km/111 miles) and MSM who inject drugs, and median distances increased with increasing rurality (large central metro: 0 km/miles; IQR, 0–83 km/52 miles; nonmetro: 103 km/64 miles; IQR, 40 km/25 miles–316 km/196 miles). Conclusion: Transmission networks in the United States involving MSM, MSM who inject drugs, or persons living in small metro and nonmetro counties may be more geographically dispersed, highlighting the importance of coordinated health department efforts for comprehensive follow-up and linkage to care.

Dynamics of HIV-1 Molecular Networks Reveal Effective Control of Large Transmission Clusters in an Area Affected by an Epidemic of Multiple HIV Subtypes

“…Non-clustering refers to an absence of links to any cases or clusters (Bbosa et al, 2019b). The non-clustered cases may be: a) the referred patients from other surveillance sites; b) inflow of cases who infected HIV at other cities; c) CHIs with long-term within-host evolution history; and d) recombinant of intra-lineages strains leading the genetic distance gap from other pure sequences.…”

“…HIV molecular networks can be used not only to guide targeted intervention in key subpopulations (Aldous et al, 2012;Lubelchek et al, 2015;Castley et al, 2017;Chaillon et al, 2017;Zhang et al, 2017;Stecher et al, 2018;Volz et al, 2018;Ragonnet-Cronin et al, 2019;Board et al, 2020), but also to reconstruct the history of HIV spread between populations (Kouyos et al, 2010;Brenner et al, 2017;Pineda-Pena et al, 2018;Delgado et al, 2019;Fabeni et al, 2019). Several local and national studies conducted in recent years have monitored the dynamics of HIV molecular clusters and evaluated their expansion speed (Chan et al, 2015;Mehta et al, 2018;Ragonnet-Cronin et al, 2018;Wertheim et al, 2018;Jovanovic et al, 2019;Dennis et al, 2020).…”

Transmission clusters, predominantly associated with men who have sex with men, play a main role in the propagation of HIV-1 in Northern Spain (2013-2018)

“…National databases of protease and reverse transcriptase (Pr-RT) sequences, primarily obtained for antiretroviral drug resistance testing, contain valuable data about HIV-1 expansion and have been used in molecular epidemiology studies (Fabeni et al, 2021;Oster et al, 2018;Parczewski et al, 2017;Petersen et al, 2018;Pineda-Peña et al, 2019;Verhofstede et al, 2018). The phylogenetic analyses performed in these studies combined with clinical and epidemiological data of the patients provide relevant public health information for the implementation of control measures and for monitoring the HIV-1 epidemic (Board et al, 2020;Brenner et al, 2013;Campbell et al, 2020;Paraskevis et al, 2019;Vasylyeva et al, 2016;Vasylyeva et al, 2020). Spanish clinical guidelines recommend to perform a genotypic drug resistance test before starting antiretroviral therapy (ART) in all HIV-1-diagnosed patients and in ARTfailing cases (AIDS study group (GESIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology and the national AIDS Plan., 2020).…”

“…Molecular epidemiology is an important tool for describing the HIV-1 epidemic (Board et al, 2020;Brenner et al, 2013;Paraskevis et al, 2016;Wertheim et al, 2017). Individuals whose transmission is related group phylogenetically in clades named transmission clusters (TCs).…”

“…perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted September 29, 2021. ; https://doi.org/10.1101/2021.09.28.21264185 doi: medRxiv preprint HIV-1 epidemic (Board et al, 2020;Brenner et al, 2013;Campbell et al, 2020;Paraskevis et al, 2019;Vasylyeva et al, 2016;Vasylyeva et al, 2020). Spanish clinical guidelines recommend to perform a genotypic drug resistance test before starting antiretroviral therapy (ART) in all HIV-1-diagnosed patients and in ARTfailing cases (AIDS study group (GESIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology and the national AIDS Plan., 2020).…”