Short Communication: HIV Type 1 Transmitted Drug Resistance and Evidence of Transmission Clusters Among Recently Infected Antiretroviral-Naive Individuals from Ugandan Fishing Communities of Lake Victoria

Abstract

Human immunodeficiency virus type 1 (HIV-1) prevalence and incidence in the fishing communities on Lake Victoria in Uganda are high. This population may play a role in driving the HIV epidemic in Uganda including the spread of transmitted drug resistance (TDR). We report data on TDR in this population among antiretroviral (ARV)-naive, recently infected individuals about 5 years after ARV scaling-up in Uganda. We identified phylogenetic transmission clusters and combined these with volunteer life histories in order to understand the sexual networks within this population. From a prospective cohort of 1,000 HIV-negative individuals recruited from five communities, 51 seroconverters were identified over a period of 2 years. From these, whole blood was collected and population sequencing of the HIV-1 pol gene ( protease/reverse transcriptase) was performed from plasma. Drug resistance mutations (DRMs) were scored using the 2009 WHO list for surveillance of TDR. TDR prevalence categories were estimated using the WHO recommended truncated sampling technique for the surveillance of TDR for use in resource-limited settings (RLS). Of the samples 92% (47/51) were successfully genotyped. HIV-1 subtype frequencies were 15/47 (32%) A1, 20/47 (43%) D, 1/47 (2%) C, 1/47 (2%) G, and 10/ 47 (21%) unique recombinant forms. Nonnucleoside reverse transcriptase inhibitor (NNRTI) drug resistance mutation K103N was identified in two individuals and V106A in one (6%) suggesting that the level of TDR was moderate in this population. No nucleoside/tide reverse transcriptase inhibitor (NRTI) or protease inhibitor (PI) DRMs were detected. In this study, we identified five transmission clusters supported by high bootstrap values and low genetic distances. Of these, one pair included the two individuals with K103N. Two of the genotypic clusters corresponded with reported sexual partnerships as detected through prior in-depth interviews. The level of TDR to NNRTIs in these ARV-naive individuals was moderate by WHO threshold survey categorization. The transmission clusters suggest a high degree of sexual partner mixing between members of these communities.

‘It is like a tomato stall where someone can pick what he likes’: structure and practices of female sex work in Kampala, Uganda

“…This travel may mean moving to a fishing site where the fish catch has been relatively good and the men have cash available or going to a workplace (construction site or oil palm plantation) on pay day. The risks involved in such mobility, because of high rates of STI infection, including HIV, at some of these sites highlighted in this study have been documented elsewhere [12,18-20]. …”

Concentrated HIV subepidemics in generalized epidemic settings

“…Transmission clusters combined with participant life histories revealed a high degree of sexual partner mixing in a high-incidence cohort in Ugandan fishing communities as only two of the five transmission clusters were from sexual partners. 70 Another study in Uganda that combined partnership histories and phylogenetic analysis of female SW identified partial sexual networks and multiple infections, suggesting mixing in these SW and their clients. 71 In the same country, another study suggested that the presence of super transmitters in early HIV infection contributed a disproportionate number of transmissions in a low-risk rural cohort.…”

Phylogenetic Studies of Transmission Dynamics in Generalized HIV Epidemics

“…84 Phylogenetic analyses have been employed in TDR prevalence studies primarily to characterize the extensive genetic diversity in specific regions 90–94 and the dominance of HIV-1C in southern Africa. 95–99 Few studies have evaluated transmission lineages of drug resistant strains through transmission cluster analysis to support or refute epidemiological linkages.…”

“…90,96,100 Transmission clusters combined with participant life histories revealed a high degree of sexual partner mixing in Ugandan fishing communities and uncovered clusters sharing similar TDR mutations. 94 Only one study incorporated antiretroviral history in the probable transmitting partners to further characterize linkages among individuals with TDR. 100 …”