title: Using HIV networks to inform real time prevention interventions.
abstract: OBJECTIVE
  To reconstruct the local HIV-1 transmission network from 1996 to 2011 and use network data to evaluate and guide efforts to interrupt transmission.
  
  
  METHODS
  HIV-1 pol sequence data were analyzed to infer the local transmission network.
  
  
  METHODS
  We analyzed HIV-1 pol sequence data to infer a partial local transmission network among 478 recently HIV-1 infected persons and 170 of their sexual and social contacts in San Diego, California. A transmission network score (TNS) was developed to estimate the risk of HIV transmission from a newly diagnosed individual to a new partner and target prevention interventions.
  
  
  RESULTS
  HIV-1 pol sequences from 339 individuals (52.3%) were highly similar to sequences from at least one other participant (i.e., clustered). A high TNS (top 25%) was significantly correlated with baseline risk behaviors (number of unique sexual partners and insertive unprotected anal intercourse (p = 0.014 and p = 0.0455, respectively) and predicted risk of transmission (p<0.0001). Retrospective analysis of antiretroviral therapy (ART) use, and simulations of ART targeted to individuals with the highest TNS, showed significantly reduced network level HIV transmission (p<0.05).
  
  
  CONCLUSIONS
  Sequence data from an HIV-1 screening program focused on recently infected persons and their social and sexual contacts enabled the characterization of a highly connected transmission network. The network-based risk score (TNS) was highly correlated with transmission risk behaviors and outcomes, and can be used identify and target effective prevention interventions, like ART, to those at a greater risk for HIV-1 transmission.
authors.affiliation: Department of Medicine, University of California, San Diego, La Jolla, California, United States of America.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Little
authors.affiliation: Department of Medicine, University of California, San Diego, La Jolla, California, United States of America.
authors.forename: Sergei L
authors.initials: SL
authors.lastname: Kosakovsky Pond
authors.affiliation: Department of Medicine, University of California, San Diego, La Jolla, California, United States of America.
authors.forename: Christy M
authors.initials: CM
authors.lastname: Anderson
authors.affiliation: Department of Medicine, University of California, San Diego, La Jolla, California, United States of America.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Young
authors.affiliation: Department of Medicine, University of California, San Diego, La Jolla, California, United States of America.
authors.forename: Joel O
authors.initials: JO
authors.lastname: Wertheim
authors.affiliation: Department of Medicine, University of California, San Diego, La Jolla, California, United States of America.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Mehta
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, Washington, United States of America.
authors.forename: Susanne
authors.initials: S
authors.lastname: May
authors.affiliation: Department of Medicine, University of California, San Diego, La Jolla, California, United States of America; Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America.
authors.forename: Davey M
authors.initials: DM
authors.lastname: Smith
mesh_terms: D000328:Adult; D002140:California; D016000:Cluster Analysis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission*; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011159:Population Surveillance; D017422:Sequence Analysis, DNA; D012725:Sexual Behavior; D012747:Sexual Partners; D055815:Young Adult; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics
chemical_list: D054302:pol Gene Products, Human Immunodeficiency Virus