title: Epidemiological study of phylogenetic transmission clusters in a local HIV-1 epidemic reveals distinct differences between subtype B and non-B infections.
abstract: BACKGROUND
  The number of HIV-1 infected individuals in the Western world continues to rise. More in-depth understanding of regional HIV-1 epidemics is necessary for the optimal design and adequate use of future prevention strategies. The use of a combination of phylogenetic analysis of HIV sequences, with data on patients' demographics, infection route, clinical information and laboratory results, will allow a better characterization of individuals responsible for local transmission.
  
  
  METHODS
  Baseline HIV-1 pol sequences, obtained through routine drug-resistance testing, from 506 patients, newly diagnosed between 2001 and 2009, were used to construct phylogenetic trees and identify transmission-clusters. Patients' demographics, laboratory and clinical data, were retrieved anonymously. Statistical analysis was performed to identify subtype-specific and transmission-cluster-specific characteristics.
  
  
  RESULTS
  Multivariate analysis showed significant differences between the 59.7% of individuals with subtype B infection and the 40.3% non-B infected individuals, with regard to route of transmission, origin, infection with Chlamydia (p = 0.01) and infection with Hepatitis C virus (p = 0.017). More and larger transmission-clusters were identified among the subtype B infections (p < 0.001). Overall, in multivariate analysis, clustering was significantly associated with Caucasian origin, infection through homosexual contact and younger age (all p < 0.001). Bivariate analysis additionally showed a correlation between clustering and syphilis (p < 0.001), higher CD4 counts (p = 0.002), Chlamydia infection (p = 0.013) and primary HIV (p = 0.017).
  
  
  CONCLUSIONS
  Combination of phylogenetics with demographic information, laboratory and clinical data, revealed that HIV-1 subtype B infected Caucasian men-who-have-sex-with-men with high prevalence of sexually transmitted diseases, account for the majority of local HIV-transmissions. This finding elucidates observed epidemiological trends through molecular analysis, and justifies sustained focus in prevention on this high risk group.
authors.affiliation: Ghent University, Belgium.
authors.forename: Kristen
authors.initials: K
authors.lastname: Chalmet
authors.forename: Delfien
authors.initials: D
authors.lastname: Staelens
authors.forename: Stijn
authors.initials: S
authors.lastname: Blot
authors.forename: Sylvie
authors.initials: S
authors.lastname: Dinakis
authors.forename: Jolanda
authors.initials: J
authors.lastname: Pelgrom
authors.forename: Jean
authors.initials: J
authors.lastname: Plum
authors.forename: Dirk
authors.initials: D
authors.lastname: Vogelaers
authors.forename: Linos
authors.initials: L
authors.lastname: Vandekerckhove
authors.forename: Chris
authors.initials: C
authors.lastname: Verhofstede
mesh_terms: D000328:Adult; D002690:Chlamydia Infections / Q000453:epidemiology; D016000:Cluster Analysis; D015897:Comorbidity; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology*; D015497:HIV-1 / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D006526:Hepatitis C / Q000453:epidemiology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D017720:Molecular Epidemiology; D010802:Phylogeny; D015995:Prevalence; D012367:RNA, Viral / Q000235:genetics*; D017422:Sequence Analysis, DNA; D017385:Sequence Homology; D044465:White People; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics
chemical_list: D012367:RNA, Viral; D054302:pol Gene Products, Human Immunodeficiency Virus
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