Billock Rachael M, France Anne Marie, Saduvala Neeraja, Panneer Nivedha, Hallmark Camden J, Wertheim Joel O, Oster Alexandra M
Division of HIV Prevention, CDC.
US Public Health Service.
AIDS. 2025 Aug 1;39(10):1403-1412. doi: 10.1097/QAD.0000000000004101. Epub 2024 Dec 23.
To estimate the influence of bursts of rapid HIV transmission on future transmission and describe populations affected by transmission bursts.
Phylogenetic analysis of US National HIV Surveillance System data.
Time-scaled phylogenetic trees were inferred for six geographic regions using sequences from persons with HIV (PWH) with diagnoses of HIV infection 2014-2019. Transmission bursts were defined as at least three adjacent inferred transmission events in the phylogeny during a detection period. We calculated the relative contribution of transmission bursts 2015-2016 to transmission 2017-2019 compared with nonbursts. Then, we detected bursts within any sliding 2-year period 2014-2019 and assessed descriptive associations of characteristics of individuals involved with or descended from transmission bursts using univariate risk ratios.
The 5.6% of phylogenetic lineages involved in transmission bursts 2015-2016 contributed to 14.9% of inferred transmission events 2017-2019. The relative contribution of lineages involved in transmission bursts to future transmission was 2.94 times that of lineages not involved in bursts. Younger age at diagnosis, self-identification as transgender or an additional gender identity, or as a cisgender man, MMSC, IDU, or MMSC and IDU, and diagnosis during acute or early infection were most strongly associated with involvement in or descendance from transmission bursts.
Transmission bursts contribute disproportionately to future HIV transmission, underscoring the value of detecting and responding to rapid transmission to reduce incidence. Bursts of rapid transmission may also contribute to enduring disparities in incidence among some key populations.
评估快速的HIV传播暴发对未来传播的影响，并描述受传播暴发影响的人群。
对美国国家HIV监测系统数据进行系统发育分析。
利用2014 - 2019年诊断为HIV感染的HIV感染者（PWH）的序列，推断六个地理区域的时间尺度系统发育树。传播暴发定义为在一个检测期内系统发育中至少三个相邻的推断传播事件。我们计算了2015 - 2016年传播暴发相对于非暴发对2017 - 2019年传播的相对贡献。然后，我们在2014 - 2019年的任何滑动2年期间检测暴发，并使用单变量风险比评估参与传播暴发或源自传播暴发的个体特征的描述性关联。
2015 - 2016年参与传播暴发的5.6%的系统发育谱系促成了2017 - 2019年14.9%的推断传播事件。参与传播暴发的谱系对未来传播的相对贡献是非暴发谱系的2.94倍。诊断时年龄较小、自我认同为跨性别者或其他性别身份、或为顺性别男性、男男性行为者、注射吸毒者、或男男性行为者与注射吸毒者，以及在急性或早期感染期间诊断，与参与传播暴发或源自传播暴发的关联最为强烈。
传播暴发对未来HIV传播的贡献不成比例，凸显了检测和应对快速传播以降低发病率的价值。快速传播暴发也可能导致一些关键人群在发病率上持续存在差异。
