Emergence of clusters of CRF02_AG and B human immunodeficiency viral strains among men having sex with men exhibiting HIV primary infection in southeastern France

Abstract

The number of new HIV diagnoses is increasing in the western world and transmission clusters have been recently identified among men having sex with men despite Highly Active Antiretroviral Therapy efficacy. The objective of this study was to assess temporal trends, epidemiological, clinical and virological characteristics of primary HIV infections. A retrospective analysis of 79 patients presenting primary HIV infections from 2005 to 2012 was performed in Marseille University Hospitals, southeastern France. Clinical, epidemiological and immunovirological data including phylogeny based on the polymerase gene were collected. 65 males and 14 females were enrolled. The main transmission route was homosexual contact (60.8%). Patients were mostly infected with subtype B (73.4%) and CRF02_AG (21.5%) HIV-1 strains. An increase in the annual number of HIV seroconversions among new HIV diagnoses from 5% in 2005 to 11.2% in 2012 (P = 0.06) and of the proportion of CRF02_AG HIV strains among primary HIV infections in 2011-2012 as compared to 2005-2010 (P = 0.055) was observed. Phylogenetic analysis revealed four transmission clusters including three transmission clusters among men having sex with men: two large clusters of nine CRF02_AG, six B HIV strains; and one small cluster of three B HIV strains. Clusters involved more frequently men (P = 0.01) belonging to caucasian ethicity (P = 0.05), with a higher HIV RNA load at inclusion (P = 0.03). These data highlight the importance of improving epidemiological surveillance and of implementing suitable prevention strategies to control the spread of HIV transmission among men having sex with men.

Epidemiological trends of HIV‐1 infection in blood donors from Catalonia, Spain (2005‐2014)

“…Studies in southeastern France and Romania have reported that the subtype B epidemic correlates with MSM practices, and clustering is often observed in this population . Our results indicated an association between HIV‐1 subtype B and MSM behavior and revealed seven HIV‐1 subtype B clusters from MSM among the 16 identified.…”

Rising prevalence of non-B HIV-1 subtypes in North Carolina and evidence for local onward transmission

“…In Europe, CRF02_AG has previously been more commonly identified in African immigrants. However, the strain has been recently described among multicultural MSM transmission networks in Spain (Bracho et al 2014) and in France (Tamalet et al 2015). In our study, while risk behavior information was only available for a subset of individuals, we found no evidence for MSM transmission among CRF02_AG or other non-B subtypes.…”

Molecular epidemiology of HIV-1 infection in Europe: An overview

“…Non-B and/or CRF clades have been introduced mainly through waves of migration from areas where are predominant and have been spread through population mobility between European countries. Subsequently their prevalence in the Central and Western European region have been increased, because of dispersal through European and mainly regionally restricted MSM, PWID and heterosexual transmission networks increasing the complexity of the epidemic de Oliveira et al, 2010;Fabeni et al, 2015;Fox et al, 2010;Hemelaar et al, 2011;Hoenigl et al, 2016;Simonetti et al, 2014;Tamalet et al, 2015). Subtype B clade still predominates in Western and Central European countries, but each country has a unique pattern shaped by different regional circumstances and high prevalent local transmission routes.…”

“…In The Netherlands the vast majority of non-Bs were linked to sub-Saharan Africa, in addition to single cases from the Caribbean, South America, Thailand, Russia and Italy (Bezemer et al, 2004;Op de Coul et al, 1998). Immigrants from sub-Saharan Africa also introduced non-B clades in France increasing the prevalence of non-B clades from 4% in the 1980s to N 20% in just a decade, mostly spreading in MSM transmission networks (Barin et al, 1997;Chaix et al, 2013;Tamalet et al, 2015). Notably in a recent study, Brand et al, found that non-B clade infections have spread among individuals of French origin and especially MSM (Brand et al, 2014).…”

“…Similarly Chaix et al found that a considerable proportion of French heterosexuals (37%) with a primary infection were infected with non-B clades . France is probably the only West European country where a much higher proportion than in other countries reaching up to 23% of French Africans citizens are infected with subtype B, suggesting that the regional sub-epidemics in native and immigrant populations are linked Tamalet et al, 2015).…”