Grossman Zehava, Avidor Boaz, Girshengoren Shirley, Katchman Eugene, Maldarelli Frank, Turner Dan
School of Public Health, Tel Aviv University, Israel.
National Cancer Institute, Frederick, Maryland.
Open Forum Infect Dis. 2019 Jul 1;6(7). doi: 10.1093/ofid/ofz304.
Subtype-A HIV was introduced into Israel in the mid-1990s, predominantly by immigrants from the former Soviet Union (FSU) infected via intravenous drug use (IVDU). HIV subsequently spread beyond the FSU-IVDU community. In 2012, a mini-HIV outbreak, associated with injection of amphetamine cathinone derivatives, started in Tel Aviv, prompting public health response. To assess current trends and the impact of the outbreak and control measures, we conducted a phyloepidemiologic analysis.
Demographic and clinical records and HIV sequences were compiled from 312 subtype-A HIV-infected individuals attending the Tel-Aviv Sourasky Medical Center between 2005-2016, where >40% of all subtype-A HIV-infected individuals in Israel are undergoing care. Molecular evolutionary genetics analysis (MEGA) and ayesian evolutionary analysis sampling trees (BEAST) programs were implemented in a phylogenetic analysis of pol sequences. Reconstructed phylogenies were assessed in the context of demographic information and drug-resistance profiles. Clusters were identified as sequence populations with posterior probability ≥0.95 of having a recent common ancestor.
After 2010, the subtype-A epidemic acquired substantial phylogenetic structure, having been unrecognized in studies covering the earlier period. Nearly 50% of all sequences were present in 11 distinct clusters consisting of 4-43 individuals. Cluster composition reflected transmission across ethnic groups, with men who have sex with men (MSM) playing an increasing role. The cathinone-associated cluster was larger than previously documented, containing variants that continued to spread within and beyond the IVDU community.
Phyloepidemiologic analysis revealed diverse clusters of HIV infection with MSM having a central role in transmission across ethic groups. A mini outbreak was reduced by public health measures, but molecular evidence of ongoing transmission suggests additional measures are necessary.
20世纪90年代中期，A型艾滋病毒被引入以色列，主要是由来自前苏联（FSU）的通过静脉注射吸毒（IVDU）感染的移民带入。艾滋病毒随后传播到了FSU-IVDU群体之外。2012年，特拉维夫开始出现与注射苯丙胺卡西酮衍生物相关的小型艾滋病毒疫情，促使公共卫生部门做出应对。为评估当前趋势以及疫情和控制措施的影响，我们进行了系统流行病学分析。
收集了2005年至2016年间在特拉维夫索拉斯基医疗中心就诊的312例感染A型艾滋病毒个体的人口统计学和临床记录以及艾滋病毒序列，以色列所有感染A型艾滋病毒个体中有40%以上在该中心接受治疗。在对pol序列进行系统发育分析时，采用了分子进化遗传学分析（MEGA）和贝叶斯进化分析采样树（BEAST）程序。在人口统计学信息和耐药性概况的背景下评估重建的系统发育。聚类被定义为具有近期共同祖先的后验概率≥0.95的序列群体。
2010年之后，A型艾滋病毒疫情呈现出显著的系统发育结构，而在涵盖早期阶段的研究中未被识别。所有序列中近50%存在于11个不同的聚类中，每个聚类由4至43人组成。聚类组成反映了不同种族群体间的传播情况，男男性行为者（MSM）的作用日益增强。与卡西酮相关的聚类比之前记录的更大，包含的变体在IVDU群体内外持续传播。
系统流行病学分析揭示了艾滋病毒感染的不同聚类，其中男男性行为者在不同种族群体间的传播中起核心作用。公共卫生措施减少了一次小型疫情，但持续传播的分子证据表明还需要采取更多措施。
