系统发生学在揭示 HIV 传播模式以实现疫情控制中的作用:魁北克的经验(2002-2020 年)。
The Role of Phylogenetics in Unravelling Patterns of HIV Transmission towards Epidemic Control: The Quebec Experience (2002-2020).
机构信息
McGill Centre for Viral Diseases, Lady Davis Institute for Medical Research, Montréal, QC H3T 1E2, Canada.
Department of Microbiology and Immunology, McGill University, Montréal, QC H4A 3J1, Canada.
出版信息
Viruses. 2021 Aug 19;13(8):1643. doi: 10.3390/v13081643.
Phylogenetics has been advanced as a structural framework to infer evolving trends in the regional spread of HIV-1 and guide public health interventions. In Quebec, molecular network analyses tracked HIV transmission dynamics from 2002-2020 using MEGA10-Neighbour-joining, HIV-TRACE, and MicrobeTrace methodologies. Phylogenetics revealed three patterns of viral spread among Men having Sex with Men (MSM, = 5024) and heterosexuals (HET, = 1345) harbouring subtype B epidemics as well as B and non-B subtype epidemics ( = 1848) introduced through migration. Notably, half of new subtype B infections amongst MSM and HET segregating as solitary transmissions or small cluster networks (2-5 members) declined by 70% from 2006-2020, concomitant to advances in treatment-as-prevention. Nonetheless, subtype B epidemic control amongst MSM was thwarted by the ongoing genesis and expansion of super-spreader large cluster variants leading to micro-epidemics, averaging 49 members/cluster at the end of 2020. The growth of large clusters was related to forward transmission cascades of untreated early-stage infections, younger at-risk populations, more transmissible/replicative-competent strains, and changing demographics. Subtype B and non-B subtype infections introduced through recent migration now surpass the domestic epidemic amongst MSM. Phylodynamics can assist in predicting and responding to active, recurrent, and newly emergent large cluster networks, as well as the cryptic spread of HIV introduced through migration.
系统发生学已被提出作为一种结构框架,以推断 HIV-1 在区域传播中的进化趋势,并指导公共卫生干预措施。在魁北克,使用 MEGA10-Neighbour-joining、HIV-TRACE 和 MicrobeTrace 方法,分子网络分析跟踪了 2002-2020 年 HIV 传播动态。系统发生学揭示了三种 HIV-1 传播模式:男男性行为者(MSM,n=5024)和异性恋者(HET,n=1345)中 B 型流行亚型以及通过移民引入的 B 型和非 B 型流行亚型(n=1848)的传播。值得注意的是,2006-2020 年期间,MSM 和 HET 中新出现的 B 型亚型感染病例中,有一半是孤立传播或小簇网络(2-5 个成员),减少了 70%,这与治疗即预防的进展有关。尽管如此,由于超级传播者大簇变体的持续产生和扩张导致微流行,从而破坏了 MSM 中 B 型流行亚型的控制,到 2020 年底,平均每个簇有 49 个成员。大簇的增长与未经治疗的早期感染的正向传播级联、更年轻的高危人群、更具传染性/复制能力的菌株以及人口结构的变化有关。通过最近移民引入的 B 型和非 B 型感染现在超过了 MSM 中的国内流行。系统发生动力学可以帮助预测和应对活跃、反复出现和新出现的大簇网络,以及通过移民引入的 HIV 的隐匿传播。
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