Sudhakar Atlesh, Wilson Donald, Devi Rachel, Balak Dashika Anshu, Singh Jenni, Tuidraki Kesaia, Gaunavinaka Lavenia, Turuva Waisale, Naivalu Taina, Lawley Blair, Tay John H, Di Giallonardo Francesca, Duchene Sebastian, Geoghegan Jemma L
Fiji Institute of Pacific Health Research, Fiji National University, Suva, Fiji.
Department of Microbiology and Immunology, University of Otago, Dunedin, 9016, New Zealand.
Npj Viruses. 2024 Mar 6;2(1):8. doi: 10.1038/s44298-024-00019-3.
Very little is known about the HIV-1 epidemic in Fiji, nor the wider South Pacific region more generally, yet new reported HIV-1 infections are on the rise. As of 2023, there are an estimated 2000 cases of HIV-1 in Fiji with heterosexual contact the primary route of transmission. In this study, we used a molecular epidemiological approach to better understand the genetic diversity of the HIV-1 epidemic in Fiji and reveal patterns of viral transmission. Between 2020 and 2021, venous blood samples were collected from people who had previously been diagnosed with HIV-1. We generated molecular data from 53 infections, representing ~2-3% of reported cases, to identify HIV-1 subtypes and determine the outbreak's trajectory. Among the 53 HIV-1 cases, we used Bayesian inference to estimate six separate introductions with at least two of these introductions leading to sustained transmission forming large, nation-wide clusters of HIV-1 subtype C. We found that since the introduction of public health interventions circa 2014, the effective reproductive number, R, decreased among the major clusters identified from an average of 2.4 to just below 1. Molecular epidemiological analysis suggested that public health efforts aimed at decreasing the spread of the disease were at least somewhat effective. Nevertheless, with a recent rise in reported HIV-1 cases, this study demonstrates the utility of molecular data to inform a more targeted public health approach for controlling its spread.
关于斐济的HIV-1疫情，乃至更广泛的南太平洋地区，人们了解甚少，但新报告的HIV-1感染病例正在增加。截至2023年，斐济估计有2000例HIV-1病例，异性接触是主要传播途径。在本研究中，我们采用分子流行病学方法，以更好地了解斐济HIV-1疫情的基因多样性，并揭示病毒传播模式。在2020年至2021年期间，从先前被诊断为HIV-1的人群中采集了静脉血样本。我们从53例感染病例中生成了分子数据，约占报告病例的2%-3%，以确定HIV-1亚型并确定疫情的发展轨迹。在这53例HIV-1病例中，我们使用贝叶斯推断法估计有六次独立的病毒引入事件，其中至少两次引入导致病毒持续传播，形成了全国范围内的大型HIV-1 C亚型集群。我们发现，自2014年左右引入公共卫生干预措施以来，在确定的主要集群中，有效再生数R从平均2.4降至略低于1。分子流行病学分析表明，旨在减少疾病传播的公共卫生努力至少在一定程度上是有效的。然而，随着最近报告的HIV-1病例增加，本研究证明了分子数据在为控制其传播制定更有针对性的公共卫生方法方面的作用。
