Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France.
Normandie Université, UNIROUEN, EA2656 GRAM, CHU de Rouen, Laboratoire de virologie associé au CNR VIH, Rouen, France.
Euro Surveill. 2019 Sep;24(39). doi: 10.2807/1560-7917.ES.2019.24.39.1800658.
BackgroundEnding the HIV pandemic must involve new tools to rapidly identify and control local outbreaks and prevent the emergence of recombinant strains with epidemiological advantages.AimThis observational study aimed to investigate in France a cluster of HIV-1 cases related to a new circulating recombinant form (CRF). The confirmation this CRF's novelty as well as measures to control its spread are presented.MethodsPhylogenetic analyses of HIV sequences routinely generated for drug resistance genotyping before 2018 in French laboratories were employed to detect the transmission chain. The CRF involved was characterised by almost full-length viral sequencing for six cases. Cases' clinical data were reviewed. Where possible, epidemiological information was collected with a questionnaire.ResultsThe transmission cluster comprised 49 cases, mostly diagnosed in 2016-2017 (n = 37). All were infected with a new CRF, CRF94_cpx. The molecular proximity of this CRF to X4 strains and the high median viraemia, exceeding 5.0 log copies/mL, at diagnosis, even in chronic infection, raise concerns of enhanced virulence. Overall, 41 cases were diagnosed in the Ile-de-France region and 45 were men who have sex with men. Among 24 cases with available information, 20 reported finding partners through a geosocial networking app. Prevention activities in the area and population affected were undertaken.ConclusionWe advocate the systematic use of routinely generated HIV molecular data by a dedicated reactive network, to improve and accelerate targeted prevention interventions. Geosocial networking apps can play a role in the spread of outbreaks, but could also deliver local targeted preventive alerts.
背景
要终结艾滋病大流行，必须要有新的工具来快速识别和控制局部疫情，并防止具有流行病学优势的重组株出现。
目的
本观察性研究旨在法国调查与一种新的循环重组形式（CRF）相关的 HIV-1 病例群。本文介绍了该 CRF 新颖性的确认以及控制其传播的措施。
方法
采用法国实验室常规进行的耐药性基因分型前 HIV 序列的系统发生分析，以检测传播链。对涉及的 CRF 进行了六个病例的全长病毒测序。对病例的临床数据进行了回顾。在可能的情况下，通过问卷调查收集了流行病学信息。
结果
传播集群包括 49 例病例，大多数于 2016-2017 年确诊（n = 37）。所有病例均感染了一种新的 CRF，即 CRF94_cpx。该 CRF 与 X4 株的分子亲缘关系密切，诊断时中位病毒载量超过 5.0 log 拷贝/ml，即使是慢性感染，也令人担忧其毒力增强。总体而言，41 例病例在法兰西岛地区确诊，45 例病例为男男性行为者。在 24 例有可用信息的病例中，有 20 例报告通过基于地理位置的社交网络应用程序找到性伴侣。在受影响的地区和人群中开展了预防活动。
结论
我们主张通过专门的反应性网络系统地利用常规生成的 HIV 分子数据，以改进和加速有针对性的预防干预措施。基于地理位置的社交网络应用程序可能在疫情传播中发挥作用，但也可以提供针对当地的预防性警报。
