Chaillon Antoine, Delaugerre Constance, Brenner Bluma, Armero Alix, Capitant Catherine, Nere Marie Laure, Leturque Nicolas, Pialoux Gilles, Cua Eric, Tremblay Cecile, Smith Davey M, Goujard Cecile, Meyer Laurence, Molina Jean Michel, Chaix Marie Laure
Department of Medicine, University of California, San Diego, San Diego, California.
Virologie, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, CNR VIH, Paris, France.
Open Forum Infect Dis. 2019 Feb 15;6(3):ofz080. doi: 10.1093/ofid/ofz080. eCollection 2019 Mar.
A better understanding of HIV transmission dynamics among populations at high risk is important for development of prevention strategies. We determined HIV transmission networks from infected individuals enrolled in the pre-exposure prophylaxis (PrEP) IPERGAY trial in combination with the ANRS PRIMO and Montreal PHI cohorts to identify and characterize active clusters of transmission in this high-risk population.
Genotypic resistance tests were performed on plasma samples from 31 IPERGAY participants. Reverse transcriptase sequences were analyzed in combination with unique HIV sequences from 1351 individuals enrolled in the PRIMO ANRS cohort (1999-2014) and 511 individuals enrolled in the Montreal PHI cohort (1996-2016). Network analyses were performed to infer putative relationships between all participants.
Overall, 1893 participants were included. Transmission network analyses revealed that 14 individuals (45.2%) from the IPERGAY trial were involved in 13 clusters sampled over a median period (interquartile range) of 2 (0.3-7.8) years, including 7 dyads and 6 larger clusters ranging from 4 to 28 individuals. When comparing characteristics between clustering individuals enrolled in the PRIMO cohort (n = 377) and in IPERGAY (n = 14), we found that IPERGAY participants had a higher viral load (5.93 vs 5.20 log copies/mL, = .032) and reported a higher number of partners in the last 2 months ( < .01).
These results demonstrate high rates of HIV transmission clustering among young high-risk MSM enrolled in the IPERGAY trial. In-depth sampling of high-risk populations may help to uncover unobserved transmission intermediaries and improve prevention efforts that could be targeted to the most active clusters.
更好地了解高危人群中的艾滋病毒传播动态对于制定预防策略至关重要。我们结合ANRS PRIMO队列和蒙特利尔PHI队列，从参与暴露前预防（PrEP）IPERGAY试验的感染个体中确定艾滋病毒传播网络，以识别和描述该高危人群中活跃的传播集群。
对31名IPERGAY参与者的血浆样本进行基因型耐药性检测。结合来自PRIMO ANRS队列（1999 - 2014年）的1351名个体和蒙特利尔PHI队列（1996 - 2016年）的511名个体的独特艾滋病毒序列，对逆转录酶序列进行分析。进行网络分析以推断所有参与者之间的假定关系。
总体而言，共纳入1893名参与者。传播网络分析显示，IPERGAY试验中的14名个体（45.2%）参与了在中位时间（四分位间距）为2（0.3 - 7.8）年期间抽样的13个集群，包括7个二元组和6个更大的集群，规模从4人到28人不等。在比较PRIMO队列（n = 377）和IPERGAY队列（n = 14）中聚类个体的特征时，我们发现IPERGAY参与者的病毒载量更高（5.93对5.20 log拷贝/毫升，P = 0.032），并且在过去2个月中报告的性伴侣数量更多（P < 0.01）。
这些结果表明，参与IPERGAY试验的年轻高危男男性行为者中艾滋病毒传播聚类率很高。对高危人群进行深入抽样可能有助于发现未被观察到的传播中介，并改善针对最活跃集群的预防措施。
