Short Communication: New HIV Infections at Southern New England Academic Institutions: Implications for Prevention

Chan, Philip A.; Kazi, Shahzeb; Rana, Aadia; Blazar, Ilyse; Dejong, Colette C.; Mayer, Kenneth H.; Huard, Thomas K.; Carleton, Kim; Gillani, Fizza S.; Alexander, Nicole; Parillo, Zoanne; Flanigan, Timothy P.; Kantor, Rami

doi:10.1089/aid.2012.0130

Cited by 12 publications

(10 citation statements)

References 24 publications

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“…Ongoing regional transmission would have been expected to result in more observed transmission clusters, but could also be limited by the existence of undiagnosed infections, mandating intensified ongoing prevention efforts. The largest subtype group (CRF02_AG) only formed transmission clusters in 9% of individuals which is low compared to other population-based studies in our community (17–30% in subtype B) (Chan et al, 2012, 2011). Individuals with subtype C formed a high proportion of phylogenetically-linked transmission clusters, likely due to mother-to-child transmission.…”

Section: Discussioncontrasting

confidence: 76%

“…Therefore, most perinatal transmission among foreign-born individuals likely occurs outside of the US. The absence of observed TDR in treatment-naïve individuals with non-B infections also suggests infection transmission outside of the US, since TDR in our community is estimated to be over 10% (Chan et al, 2012, 2011). TDR in many African countries is still less common due to later introduction of ARVs (Chan and Kantor, 2009).…”

Section: Discussionmentioning

confidence: 78%

“…Phylogenetic characterization of HIV pol sequences can identify clusters of sequences with common ancestors that may be indicative of ongoing local HIV transmission in a community (Brenner et al, 2011; Chan et al, 2012, 2011; Lewis et al, 2008). Lack of, or limited, clustering in a well-represented epidemic suggests unlinked infections and multiple, independent viral introductions.…”

Section: Introductionmentioning

confidence: 99%

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Phylogenetic and geospatial evaluation of HIV-1 subtype diversity at the largest HIV center in Rhode Island

Chan

Reitsma

DeLong

et al. 2014

Infection, Genetics and Evolution

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Individuals infected with HIV-1 non-B subtypes are understudied in the United States. Their characterization may augment prevention and treatment interventions. We examined the regional molecular epidemiology of non-B subtypes using a combined phylogenetic and geospatial approach. HIV-1 pol sequences and clinical data obtained for routine clinical care were aggregated from 2004–2011 at the largest HIV center in Rhode Island. Subtyping was performed by neighbor-joining and maximum-likelihood phylogeny and compared across eight commonly used tools (HIVdb, REGA, RIP, NCBI, Geno2Pheno, EuResist, jpHMM and STAR) using proportional odds ordinal regression. Individuals with non-B subtypes were characterized according to demographics and risk factors for infection, intra-subtype clustering by maximum-likelihood phylogeny, and geospatial hotspot analysis using Getis-Ord Gi* statistics. Of 1,277 unique sequences, phylogenetic subtyping demonstrated 8.3% (N=106, 95% CI 6.8%–10%) non-B subtypes and circulating recombinant forms (CRFs): CRF02_AG=46; A=15; C=15; CRF01_AE=6; CRF06_CPX=5; CRF14_BG=5; G=3; CRF43_02G=3; D=3; CRF24_BG=3; CRF11_CPX=1; F1=1. Compared to phylogeny, Geno2Pheno was the most concordant (86% exact match) followed by REGA (85%), EuResist (85%) and STAR (82%). Of 106 individuals with non-B subtypes, 50% were male, 71% acquired infection through heterosexual transmission; 76%, were born in Africa, 6% Southeast Asia, 5% the United States, 3% Central America, 1% Europe, and 9% unknown. Eighty percent of CRF02_AG, 93% of A and 87% of C sequences were from African-born individuals. Twenty-two percent of non-B subtypes formed transmission clusters, including a significant number of younger individuals with perinatally-acquired infection. Geospatial analyses revealed hotspots of B and non-B subtypes in the state capital with a more concentrated focus among non-B subtypes. Molecular examination of regional HIV diversity revealed a larger than expected non-subtype B infected population, mostly born in Africa, with low ongoing regional transmission. Phylogenetic and geospatial characterization of infection clusters is helpful to identify targets for treatment and prevention interventions.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

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Phylogenetic and geospatial evaluation of HIV-1 subtype diversity at the largest HIV center in Rhode Island

Chan

Reitsma

DeLong

et al. 2014

Infection, Genetics and Evolution

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“…Our previous work in RI demonstrated the presence of small-scale transmission clusters among sequences from MSM 11,53 which were associated with local sex club venues 54 . In this study, evaluation of putative transmission clusters using a comprehensive set of HIV-1 pol sequences in the entire state, identified significant local sexual transmission patterns among MSM.…”

Section: Discussionmentioning

confidence: 94%

Phylogenetic Investigation of a Statewide HIV-1 Epidemic Reveals Ongoing and Active Transmission Networks Among Men Who Have Sex With Men

Chan

Hogan

Huang

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Molecular epidemiologic evaluation of HIV-1 transmission networks can elucidate behavioral components of transmission that can be targets for intervention. Methods We combined phylogenetic and statistical approaches using pol sequences from patients diagnosed 2004-2011 at a large HIV center in Rhode Island, following 75% of the state’s HIV population. Phylogenetic trees were constructed using maximum likelihood and putative transmission clusters were evaluated using latent class analyses (LCA) to determine association of cluster size with underlying demographic/behavioral characteristics. A logistic growth model was used to assess intra-cluster dynamics over time and predict “active” clusters that were more likely to harbor undiagnosed infections. Results Of 1,166 HIV-1 subtype B sequences, 31% were distributed among 114 statistically-supported, monophyletic clusters (range: 2-15 sequences/cluster). Sequences from men who have sex with men (MSM) formed 52% of clusters. LCA demonstrated that sequences from recently diagnosed (2008-2011) MSM with primary HIV infection (PHI) and other sexually transmitted infections (STIs) were more likely to form larger clusters (Odds Ratio 1.62-11.25, p<0.01). MSM in clusters were more likely to have anonymous partners and meet partners at sex clubs and pornographic stores. Four large clusters with 38 sequences (100% male, 89% MSM) had a high-probability of harboring undiagnosed infections and included younger MSM with PHI and STIs. Conclusions In this first large-scale molecular epidemiologic investigation of HIV-1 transmission in New England, sexual networks among recently diagnosed MSM with PHI and concomitant STIs contributed to ongoing transmission. Characterization of transmission dynamics revealed actively growing clusters which may be targets for intervention.

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“…In November of 2010, three new cases of acute/recent HIV infection were reported in college students in Rhode Island [17]. These cases, which were diagnosed at local college health centers, suggested there was ongoing transmission in the college community, specifically during the acute phase of HIV when antibody testing can be negative and the risk of transmission is increased [18].…”

Section: Introductionmentioning

confidence: 99%

HIV testing practices among New England college health centers

et al. 2013

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BackgroundThe prevalence of human immunodeficiency virus (HIV) continues to increase among certain populations including young men who have sex with men (MSM). College campuses represent a potential setting to engage young adults and institute prevention interventions including HIV testing. The purpose of this study was to evaluate testing practices for HIV and other sexually transmitted infections (STIs) on college campuses.MethodsMedical directors at four-year residential baccalaureate college health centers in New England were surveyed from June, 2011 to September, 2011. Thirty-one interviews were completed regarding experiences with HIV testing, acute HIV infection, other STI testing, and outreach efforts targeting specific at-risk groups such as MSM.ResultsAmong schools that responded to the survey, less than five percent of students were tested for HIV at their local college health center in the past academic year (2010–2011). Significant barriers to HIV testing included cost and availability of rapid antibody testing. One-third of college health medical directors reported that their practitioners may not feel comfortable recognizing acute HIV infection.ConclusionsImproved HIV testing practices are needed on college campuses. Programs should focus on outreach efforts targeting MSM and other at-risk populations.

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Short Communication: New HIV Infections at Southern New England Academic Institutions: Implications for Prevention

Cited by 12 publications

References 24 publications

Phylogenetic and geospatial evaluation of HIV-1 subtype diversity at the largest HIV center in Rhode Island

Phylogenetic and geospatial evaluation of HIV-1 subtype diversity at the largest HIV center in Rhode Island

Phylogenetic Investigation of a Statewide HIV-1 Epidemic Reveals Ongoing and Active Transmission Networks Among Men Who Have Sex With Men

HIV testing practices among New England college health centers

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