New HIV-1 circulating recombinant form 94: from phylogenetic detection of a large transmission cluster to prevention in the age of geosocial-networking apps in France, 2013 to 2017

Abstract

BackgroundEnding the HIV pandemic must involve new tools to rapidly identify and control local outbreaks and prevent the emergence of recombinant strains with epidemiological advantages.AimThis observational study aimed to investigate in France a cluster of HIV-1 cases related to a new circulating recombinant form (CRF). The confirmation this CRF’s novelty as well as measures to control its spread are presented.MethodsPhylogenetic analyses of HIV sequences routinely generated for drug resistance genotyping before 2018 in French laboratories were employed to detect the transmission chain. The CRF involved was characterised by almost full-length viral sequencing for six cases. Cases’ clinical data were reviewed. Where possible, epidemiological information was collected with a questionnaire.ResultsThe transmission cluster comprised 49 cases, mostly diagnosed in 2016–2017 (n = 37). All were infected with a new CRF, CRF94_cpx. The molecular proximity of this CRF to X4 strains and the high median viraemia, exceeding 5.0 log10 copies/mL, at diagnosis, even in chronic infection, raise concerns of enhanced virulence. Overall, 41 cases were diagnosed in the Ile-de-France region and 45 were men who have sex with men. Among 24 cases with available information, 20 reported finding partners through a geosocial networking app. Prevention activities in the area and population affected were undertaken.ConclusionWe advocate the systematic use of routinely generated HIV molecular data by a dedicated reactive network, to improve and accelerate targeted prevention interventions. Geosocial networking apps can play a role in the spread of outbreaks, but could also deliver local targeted preventive alerts.

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)

“…Consequently, reinforcement of public health measures for preventing HIV-1 infections in MSM, such as behavioral interventions to reduce risky practices, pre-exposure prophylaxis (Grant et al, 2010;McCormack et al, 2016;Riddell et al, 2018) 2015) are recommended. In addition, new strategies and other tools for reaching the MSM population, such as the apps for sex dating suggested in other studies (Duncan et al, 2018;Wirden et al, 2019) could be considered for preventing HIV-1 infections.…”

The ethical and epistemological pitfalls of translating phylogenetic HIV testing: from patient-centered care to surveillance

“…This article is not based on any qualitative date such as interviews, or field notes, nor is it based on data sets such consisting of numbers, statistics or the like. The article was conducted based on a content analysis of the following academic articles, as well as those cited and listed in the references list (Haillon et al, 2017;Chan et al, 2015;Dennis et al, 2015;German et al, 2017;González-Alba et al, 2011;Hué et al, 2014;Little et al, 2014;Oster et al, 2015Oster et al, , 2018aOster et al, , 2018bPoon et al, 2016;Ragonnet-Cronin et al, 2019;Smith et al, 2009;Wirden et al, 2019).…”

“…As such, the US Centers for Disease Control (CDC) has heralded molecular surveillance as a "critical step toward bringing the nation closer to the goal of no new infections." 1 Molecular HIV surveillance is also practiced in Canada (Poon et al, 2016), and studies on its usage have been conducted in Spain (González-Alba et al, 2011), Italy (Lai et al, 2020), and France (Chaillon et al, 2017;Wirden et al, 2019). Every American health authority deploying this approach "takes aggregate data from people's HIV blood tests and compares it molecularly to identify groupings of genetically similar virus that are connected temporally, geographically, and by stage of infection.…”

HIV Prevention Concepts—Counter Movements Challenging Societies

“…Such cluster meetings of the vulnerable groups mentioned here have consequences: As the relative compaction of HIV-infected people both with and without cART is higher during these meetings than in situations of casual dates, these cluster arrangements provide a favorable potential for more effective spread of HIV and other STIs. Furthermore, these situations include the potential for HIV to spread its changing virulence; [73] and double or even multiple superinfections with HIV among participants infected with HIV of different clades may happen, thereby providing conditions for recombination at their genomic DNA level resulting in circulating recombinant forms (CRFs) [73]. The analysis of at-risk people susceptible to chemsex settings highlights a variety of reasons why current prevention concepts are unrealistic tools [74] [75] [76].…”