University College London, United Kingdom.
Perinatal Prevention of AIDS Initiative, Odessa, Ukraine.
Clin Infect Dis. 2017 Oct 1;65(7):1127-1135. doi: 10.1093/cid/cix499.
The human immunodeficiency virus (HIV) epidemic in Ukraine has been driven by a rapid rise among people who inject drugs, but recent studies have shown an increase through sexual transmission.
Protease and reverse transcriptase sequences from 876 new HIV diagnoses (April 2013-March 2015) in Kiev were linked to demographic data. We constructed phylogenetic trees for 794 subtype A1 and 64 subtype B sequences and identified factors associated with transmission clustering. Clusters were defined as ≥2 sequences, ≥80% local branch support, and maximum genetic distance of all sequence pairs in the cluster ≤2.5%. Recent infection was determined through the limiting antigen avidity enzyme immunoassay. Sequences were analyzed for transmitted drug resistance mutations.
Thirty percent of subtype A1 and 66% of subtype B sequences clustered. Large clusters (maximum 11 sequences) contained mixed risk groups. In univariate analysis, clustering was significantly associated with subtype B compared to A1 (odds ratio [OR], 4.38 [95% confidence interval {CI}, 2.56-7.50]); risk group (OR, 5.65 [95% CI, 3.27-9.75]) for men who have sex with men compared to heterosexual males; recent, compared to long-standing, infection (OR, 2.72 [95% CI, 1.64-4.52]); reported sex work contact (OR, 1.93 [95% CI, 1.07-3.47]); and younger age groups compared with age ≥36 years (OR, 1.83 [95% CI, 1.10-3.05] for age ≤25 years). Females were associated with lower odds of clustering than heterosexual males (OR, 0.49 [95% CI, .31-.77]). In multivariate analysis, risk group, subtype, and age group were independently associated with clustering (P < .001, P = .007, and P = .033, respectively). Eighteen sequences (2.1%) indicated evidence of transmitted drug resistance.
Our findings suggest high levels of transmission and bridging between risk groups.
乌克兰的人类免疫缺陷病毒（HIV）疫情主要由注射吸毒者中的快速上升所驱动，但最近的研究表明，性传播也在增加。
将 876 例新的 HIV 诊断病例（2013 年 4 月至 2015 年 3 月，基辅）的蛋白酶和逆转录酶序列与人口统计学数据相关联。我们构建了 794 例亚型 A1 和 64 例亚型 B 序列的系统进化树，并确定了与传播聚类相关的因素。聚类定义为≥2 个序列，≥80%的局部分支支持，以及聚类中所有序列对的最大遗传距离≤2.5%。通过限制抗原亲和力酶免疫测定法确定近期感染。对序列进行传播耐药性突变分析。
30%的亚型 A1 和 66%的亚型 B 序列聚类。大的聚类（最大 11 个序列）包含混合风险群体。在单变量分析中，与亚型 A1 相比，聚类与亚型 B 显著相关（比值比[OR]，4.38[95%置信区间{CI}，2.56-7.50]）；与异性恋男性相比，男男性接触者的风险群体（OR，5.65[95% CI，3.27-9.75]）；近期感染，而非长期感染（OR，2.72[95% CI，1.64-4.52]）；报告的性工作接触（OR，1.93[95% CI，1.07-3.47]）；与≥36 岁年龄组相比，年龄≤25 岁的年龄组（OR，1.83[95% CI，1.10-3.05]）。与异性恋男性相比，女性聚类的可能性较低（OR，0.49[95% CI，0.31-0.77]）。在多变量分析中，风险群体、亚型和年龄组与聚类独立相关（P<.001，P=0.007，P=0.033）。18 个序列（2.1%）表明存在传播耐药性的证据。
我们的研究结果表明，不同风险群体之间存在高水平的传播和传播。
