Brenner Bluma G, Roger Michel, Routy Jean-Pierre, Moisi Daniela, Ntemgwa Michel, Matte Claudine, Baril Jean-Guy, Thomas Rejéan, Rouleau Danielle, Bruneau Julie, Leblanc Roger, Legault Mario, Tremblay Cecile, Charest Hugues, Wainberg Mark A
McGill AIDS Centre-Jewish General Hospital, Montreal, Canada.
J Infect Dis. 2007 Apr 1;195(7):951-9. doi: 10.1086/512088. Epub 2007 Feb 16.
A population-based phylogenetic approach was used to characterize human immunodeficiency virus (HIV)-transmission dynamics in Quebec.
HIV-1 pol sequences included primary HIV infections (PHIs; <6 months after seroconversion) from the Quebec PHI cohort (1998-2005; n=215) and the provincial genotyping program (2001-2005; n=481). Phylogenetic analysis determined sequence interrelationships among unique PHIs (n=593) and infections from untreated (n=135) and treated (n=660) chronically infected (CI) potential transmitter populations (2001-2005). Clinical features, risk factors, and drug resistance for clustered and nonclustered transmission events were ascertained.
Viruses from 49.4% (293/593) of PHIs cosegregated into 75 transmission chains with 2-17 transmissions/cluster. Half of the clusters included 2.7+/-0.8 (mean+/-SD) transmissions, whereas the remainder had 8.8+/-3.5 transmissions. Maximum periods for onward transmission in clusters were 15.2+/-9.5 months. Coclustering of untreated and treated CIs with PHIs were infrequent (6.2% and 4.8%, respectively). The ages, viremia, and risk factors were similar for clustered and nonclustered transmission events. Low prevalence of drug resistance in PHI supported amplified transmissions at early stages.
Early infection accounts for approximately half of onward transmissions in this urban North American study. Therapy at early stages of disease may prevent onward HIV transmission.
采用基于人群的系统发育方法来描述魁北克省人类免疫缺陷病毒（HIV）的传播动态。
HIV-1 pol序列包括来自魁北克原发性HIV感染队列（1998 - 2005年；n = 215）和省级基因分型项目（2001 - 2005年；n = 481）的原发性HIV感染（PHIs；血清转换后<6个月）。系统发育分析确定了独特的PHIs（n = 593）以及来自未治疗（n = 135）和治疗（n = 660）的慢性感染（CI）潜在传播人群（2001 - 2005年）的感染之间的序列相互关系。确定了聚集性和非聚集性传播事件的临床特征、危险因素和耐药性。
49.4%（293/593）的PHIs病毒共分为75个传播链，每个聚集簇有2 - 17次传播。一半的聚集簇包含2.7±0.8（均值±标准差）次传播，而其余的有8.8±3.5次传播。聚集簇中后续传播的最长时间为15.2±9.5个月。未治疗和治疗的慢性感染者与PHIs的共聚集情况不常见（分别为6.2%和4.8%）。聚集性和非聚集性传播事件的年龄、病毒血症和危险因素相似。PHI中耐药性的低流行率支持了早期阶段传播的增加。
在这项北美城市研究中，早期感染约占后续传播病例的一半。疾病早期进行治疗可能会预防HIV的后续传播。
