Kostaki Evangelia Georgia, Hodges-Mameletzis Ioannis, Magiorkinis Gkikas, Adamis Georgios, Xylomenos Georgios, Nikolopoulos Georgios, Lazanas Marios, Chini Maria, Mangafas Nikos, Skoutelis Athanasios, Papastamopoulos Vasileios, Antoniadou Anastasia, Papadopoulos Antonios, Protopapas Konstantinos, Psichogiou Mina, Basoulis Dimitrios, Chrysos Georgios, Paraskeva Dimitra, Paparizos Vasileios, Kourkounti Sofia, Sambatakou Helen, Sipsas Nikolaos V, Lada Malvina, Panagopoulos Periklis, Maltezos Efstratios, Hatzakis Angelos, Paraskevis Dimitrios
Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
HIV Department, World Health Organization, Geneva, Switzerland.
Sex Transm Infect. 2021 May;97(3):232-237. doi: 10.1136/sextrans-2020-054509. Epub 2020 Jun 19.
Subtypes A1 and B are the most prevalent HIV-1 clades in Greece. Subtype A1 epidemic is highly monophyletic and corresponds to transmissions that occurred locally. Our aim in this molecular epidemiology analysis was to investigate the role of early treatment in preventing new HIV-1 transmissions.
Our analysis focused on 791 subtype A1 sequences from treatment-naïve individuals in Greece. Estimation of infection dates was performed by molecular clock calculations using Bayesian methods. We estimated the time interval between (1) the infection and sampling dates (linkage to care window), (2) the sampling dates and antiretroviral therapy (ART) initiation (treatment window), and (3) the infection dates and ART initiation (transmissibility window) for the study population. We also inferred the putative source of HIV infections between individuals of different groups divided according to the length of treatment, linkage to care or transmissibility window.
A significant decline was detected for the treatment window during 2014-2015 versus the 2 previous years (p=0.0273), while the linkage to care interval remained unchanged during the study period. Inference of the putative source of HIV infections suggested that individuals with a recent diagnosis or narrow transmissibility window (time period between HIV infection and ART initiation) were not sources of HIV infections to other groups. Contrarily, a significant number of HIV infections originated from individuals with longer transmissibility window interval.
Our findings showed that the treatment window is decreasing over time, presumably due to the updated treatment guidelines. Our study also demonstrates that people treated earlier after infection do not transmit at high rates, thus documenting the benefits of early ART initiation in preventing ongoing HIV-1 transmission.
A1和B亚型是希腊最常见的HIV-1分支。A1亚型流行具有高度单系性，与当地发生的传播相对应。本分子流行病学分析的目的是研究早期治疗在预防新的HIV-1传播中的作用。
我们的分析聚焦于希腊791例未接受过治疗个体的A1亚型序列。使用贝叶斯方法通过分子钟计算对感染日期进行估计。我们估计了研究人群中（1）感染日期与采样日期之间的时间间隔（与治疗关联期）、（2）采样日期与抗逆转录病毒治疗（ART）开始之间的时间间隔（治疗期）以及（3）感染日期与ART开始之间的时间间隔（传播期）。我们还推断了根据治疗时长、与治疗关联或传播期划分的不同组个体之间HIV感染的推定来源。
与前两年相比，2014 - 2015年治疗期出现显著下降（p = 0.0273），而在研究期间与治疗关联期保持不变。对HIV感染推定来源的推断表明，近期诊断或传播期较短（HIV感染与ART开始之间的时间段）的个体不是其他组HIV感染的来源。相反，大量HIV感染源自传播期较长的个体。
我们的研究结果表明，随着时间推移治疗期在缩短，可能是由于治疗指南的更新。我们的研究还表明，感染后较早接受治疗的人传播率不高，从而证明了早期开始ART在预防持续HIV-1传播方面的益处。
