Effective Human Immunodeficiency Virus Molecular Surveillance Requires Identification of Incident Cases of Infection.

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BACKGROUND

Ending the human immunodeficiency virus (HIV) epidemic requires knowledge of key drivers of spread of HIV infection.

METHODS

Between 1996 and 2018, 1119 newly and previously diagnosed, therapy-naive persons with HIV (PWH) from San Diego were followed. A genetic distance-based network was inferred using pol sequences, and genetic clusters grew over time through linkage of sequences from newly observed infections. Cox proportional hazards models were used to identify factors associated with the rate of growth. These results were used to predict the impact of a hypothetical intervention targeting PWH with incident infection. Comparison was made to the Centers for Disease Control and Prevention (CDC) Ending the HIV Epidemic (EHE) molecular surveillance strategy, which prioritizes clusters recently linked to all new HIV diagnoses and does not incorporate data on incident infections.

RESULTS

Overall, 219 genetic linkages to incident infections were identified over a median follow-up of 8.8 years. Incident cluster growth was strongly associated with proportion of PWH in the cluster who themselves had incident infection (hazard ratio, 44.09 [95% confidence interval, 17.09-113.78]). The CDC EHE molecular surveillance strategy identified 11 linkages to incident infections a genetic distance threshold of 0.5%, and 24 linkages at 1.5%.

CONCLUSIONS

Over the past 2 decades, incident infections drove incident HIV cluster growth in San Diego. The current CDC EHE molecular detection and response strategy would not have identified most transmission events arising from those with incident infection in San Diego. Molecular surveillance that includes detection of incident cases will provide a more effective strategy for EHE.

Investigators
Abbreviation
Clin Infect Dis
Publication Date
2021-09-09
Volume
73
Issue
5
Page Numbers
842-849
Pubmed ID
34492694
Medium
Print
Full Title
Effective Human Immunodeficiency Virus Molecular Surveillance Requires Identification of Incident Cases of Infection.
Authors
Little SJ, Chen T, Wang R, Anderson C, Pond SK, Nakazawa M, Mathews WC, DeGruttola V, Smith DM