Zeh Clement, Inzaule Seth C, Ondoa Pascale, Nafisa Lillian G, Kasembeli Alex, Otieno Fredrick, Vandenhoudt Hilde, Amornkul Pauli N, Mills Lisa A, Nkengasong John N
US Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention (CDC), Kisumu, Kenya.
Kenya Medical Research Institute (KEMRI)/CDC Research and Public Health Collaboration, Kisumu Field Research Station, Kisumu, Kenya.
PLoS One. 2016 Feb 12;11(2):e0147436. doi: 10.1371/journal.pone.0147436. eCollection 2016.
OBJECTIVE: To identify unique characteristics of recent versus established HIV infections and describe sexual transmission networks, we characterized circulating HIV-1 strains from two randomly selected populations of ART-naïve participants in rural western Kenya. METHODS: Recent HIV infections were identified by the HIV-1 subtype B, E and D, immunoglobulin G capture immunoassay (IgG BED-CEIA) and BioRad avidity assays. Genotypic and phylogenetic analyses were performed on the pol gene to identify transmitted drug resistance (TDR) mutations, characterize HIV subtypes and potential transmission clusters. Factors associated with recent infection and clustering were assessed by logistic regression. RESULTS: Of the 320 specimens, 40 (12.5%) were concordantly identified by the two assays as recent infections. Factors independently associated with being recently infected were age ≤19 years (P = 0.001) and history of sexually transmitted infections (STIs) in the past six months (P = 0.004). HIV subtype distribution differed in recently versus chronically infected participants, with subtype A observed among 53% recent vs. 68% chronic infections (p = 0.04) and subtype D among 26% recent vs. 12% chronic infections (p = 0.012). Overall, the prevalence of primary drug resistance was 1.16%. Of the 258 sequences, 11.2% were in monophyletic clusters of between 2-4 individuals. In multivariate analysis factors associated with clustering included having recent HIV infection P = 0.043 and being from Gem region P = 0.002. CONCLUSIONS: Recent HIV-1 infection was more frequent among 13-19 year olds compared with older age groups, underscoring the ongoing risk and susceptibility of younger persons for acquiring HIV infection. Our findings also provide evidence of sexual networks. The association of recent infections with clustering suggests that early infections may be contributing significant proportions of onward transmission highlighting the need for early diagnosis and treatment as prevention for ongoing prevention. Larger studies are needed to better understand the structure of these networks and subsequently implement and evaluate targeted interventions.
目的：为了确定近期感染与已确诊的HIV感染的独特特征并描述性传播网络，我们对肯尼亚西部农村地区两个随机选取的未接受抗逆转录病毒治疗（ART）参与者群体中的循环HIV-1毒株进行了特征分析。 方法：通过HIV-1 B、E和D亚型免疫球蛋白G捕获免疫测定法（IgG BED-CEIA）和伯乐亲和力测定法来识别近期HIV感染。对pol基因进行基因分型和系统发育分析，以确定传播性耐药（TDR）突变、表征HIV亚型和潜在传播簇。通过逻辑回归评估与近期感染和聚类相关的因素。 结果：在320份标本中，两种检测方法一致鉴定出40份（12.5%）为近期感染。与近期感染独立相关的因素为年龄≤19岁（P = 0.001）以及过去六个月内有性传播感染（STI）史（P = 0.004）。近期感染与慢性感染参与者的HIV亚型分布不同，A亚型在近期感染中占53%，在慢性感染中占68%（p = 0.04）；D亚型在近期感染中占26%，在慢性感染中占12%（p = 0.012）。总体而言，原发性耐药的患病率为1.16%。在258个序列中，11.2%处于2至4人组成的单系簇中。在多变量分析中，与聚类相关的因素包括近期感染HIV（P = 0.043）以及来自Gem地区（P = 0.002）。 结论：与年龄较大的人群相比，13至19岁人群中近期HIV-1感染更为频繁，这突出了年轻人感染HIV的持续风险和易感性。我们的研究结果也为性网络提供了证据。近期感染与聚类之间的关联表明，早期感染可能在很大比例的后续传播中起作用，这凸显了将早期诊断和治疗作为持续预防措施的必要性。需要开展更大规模的研究，以更好地了解这些网络的结构，随后实施并评估有针对性的干预措施。
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