HIV-1 Transmission During Recent Infection and During Treatment Interruptions as Major Drivers of New Infections in the Swiss HIV Cohort Study

Marzel, Alex; Shilaih, Mohaned; Yang, Wan-Lin; Böni, Jürg; Yerly, Sabine; Klimkait, Thomas; Aubert, Vincent; Braun, Dominique L; Calmy, Alexandra; Furrer, Hansjakob; Cavassini, Matthias; Battegay, Manuel; Vernazza, Pietro; Bernasconi, Enos; Günthard, Huldrych F.; Kouyos, Roger D.

doi:10.1093/cid/civ732

Cited by 59 publications

(53 citation statements)

References 28 publications

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“…HIV pol sequences from infected individuals were obtained from patients enrolled in the Swiss HIV Cohort Study [47–49]. To minimize the effects of spatial structure, we focus on a single large sub-epidemic identified as primarily occurring in the Zürich region in a preliminary phylogenetic analysis (see S1 Text and S4 Fig).…”

Section: Resultsmentioning

confidence: 99%

Phylodynamics on local sexual contact networks

et al. 2017

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Phylodynamic models are widely used in infectious disease epidemiology to infer the dynamics and structure of pathogen populations. However, these models generally assume that individual hosts contact one another at random, ignoring the fact that many pathogens spread through highly structured contact networks. We present a new framework for phylodynamics on local contact networks based on pairwise epidemiological models that track the status of pairs of nodes in the network rather than just individuals. Shifting our focus from individuals to pairs leads naturally to coalescent models that describe how lineages move through networks and the rate at which lineages coalesce. These pairwise coalescent models not only consider how network structure directly shapes pathogen phylogenies, but also how the relationship between phylogenies and contact networks changes depending on epidemic dynamics and the fraction of infected hosts sampled. By considering pathogen phylogenies in a probabilistic framework, these coalescent models can also be used to estimate the statistical properties of contact networks directly from phylogenies using likelihood-based inference. We use this framework to explore how much information phylogenies retain about the underlying structure of contact networks and to infer the structure of a sexual contact network underlying a large HIV-1 sub-epidemic in Switzerland.

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Section: Resultsmentioning

confidence: 99%

Phylodynamics on local sexual contact networks

et al. 2017

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“…Planned discontinuation of early ART after a specific duration of treatment is not recommended outside research settings; the benefits do not persist and the subsequent viral rebound is associated with increased clinical events and the potential for transmission (evidence rating AIa). 16–18 …”

Section: When To Startmentioning

confidence: 99%

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Günthard

Saag

Benson

et al. 2016

JAMA

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“…Transmission during the period of acute/early infection is particularly likely910 because of high viral load levels11, lack of immune response, and elevated rates of risky behaviors1213. Phylogenetic studies suggest that the recent phase may account for up to half of onward transmissions1314.…”

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A network intervention that locates and intervenes with recently HIV-infected persons: The Transmission Reduction Intervention Project (TRIP)

Nikolopoulos

Pavlitina²,

Muth³

et al. 2016

Sci Rep

102

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Early treatment, soon after infection, reduces HIV transmissions and benefits patients. The Transmission Reduction Intervention Project (TRIP) evaluated a network intervention to detect individuals recently infected (in the past 6 months). TRIP was conducted in Greece (2013–2015) and focused on drug injector networks. Based on HIV status, testing history, and the results of an assay to detect recent infections, TRIP classified drug injector “Seeds” into groups: Recent Seeds (RS), and Control Seeds with Long-term HIV infection (LCS). The network members of RS and LCS were traced for two steps. The analysis included 23 RS, 171 network members of the RS, 19 LCS, and 65 network members of the LCS. The per-seed number of recents detected in the network of RS was 5 times the number in the network of LCS (Ratio RS vs. LCS: 5.23; 95% Confidence Interval (CI): 1.54–27.61). The proportion of recents among HIV positives in the network of RS (27%) was approximately 3 times (Ratio RS vs. LCS: 3.30; 95% CI: 1.04–10.43) that in the network of LCS (8%). Strategic network tracing that starts with recently infected persons could support public health efforts to find and treat people early in their HIV infection.

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HIV-1 Transmission During Recent Infection and During Treatment Interruptions as Major Drivers of New Infections in the Swiss HIV Cohort Study

Abstract: We demonstrate a high fraction of transmission during recent HIV infection but also chronic transmissions after interruption of ART in Switzerland. Both represent key issues for treatment as prevention and underline the importance of early diagnosis and of early and continuous treatment.

Cited by 59 publications

References 28 publications

Phylodynamics on local sexual contact networks

Phylodynamics on local sexual contact networks

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

A network intervention that locates and intervenes with recently HIV-infected persons: The Transmission Reduction Intervention Project (TRIP)

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