title: Targeting HIV Prevention Based on Molecular Epidemiology Among Deeply Sampled Subnetworks of Men Who Have Sex With Men.
abstract: BACKGROUND
  Molecular epidemiology can be useful in identifying clusters of human immunodeficiency virus (HIV) transmission that can be targeted for prevention.
  
  
  METHODS
  Regular screening of 2000 men who have sex with men (MSM) in Beijing, China, for HIV infection every 2 months identified 179 primary infections (2007-2010). HIV-1 pol sequences were obtained and used to infer the transmission network and identify transmitted drug resistance (TDR) among these individuals. We evaluated the use of clinical and network information to target prevention efforts. Prevention efficiency was calculated as the number of infections saved per number of interventions.
  
  
  RESULTS
  This cohort was infected with HIV-1 subtype B (28%), circulating recombinant form (CRF)_01 AE (53%), and CRF_07 BC (16%). The overall rate of TDR was low (5%), but the rate of clustering was high (64%), suggesting deep sampling of the subnetwork. Provision of a theoretically high-efficacy intervention like antiretroviral therapy to all participants had a prevention efficiency of 23%. The efficiency of targeting prevention based on lower CD4 counts (<200 cells/mL, <350 cells/mL, or <500 cells/mL) and higher viral loads (>100 000 copies/mL and >50 000 copies/mL) was between 10% and 18%. The efficiency of targeting prevention based on number of network connections was much higher (30%-42%). For example, treating the 33 participants with ≥5 connections in 2009 would have theoretically prevented 14 infections in 2010 (42% prevention efficiency).
  
  
  CONCLUSIONS
  Regular HIV testing of MSM in Beijing can deeply sample the local transmission subnetwork, and targeting prevention efforts based on network connectivity may be an efficient way to deliver prevention interventions.
authors.affiliation: Department of Infectious Diseases, Yunnan Provincial Hospital of Infectious Diseases, Kunming.
authors.forename: Xicheng
authors.initials: X
authors.lastname: Wang
authors.affiliation: Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing.
authors.forename: Yasong
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Infectious Diseases, Yunnan Provincial Hospital of Infectious Diseases, Kunming.
authors.forename: Lin
authors.initials: L
authors.lastname: Mao
authors.affiliation: Center for Infectious Diseases, Beijing YouAn Hospital, Capital Medical University, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Xia
authors.affiliation: Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Center for Infectious Diseases, Beijing YouAn Hospital, Capital Medical University, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Dai
authors.affiliation: University of California San Diego Veterans Affairs Healthcare System San Diego, California.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Mehta
authors.affiliation: University of California San Diego.
authors.forename: Joel O
authors.initials: JO
authors.lastname: Wertheim
authors.affiliation: Department of Infectious Diseases, Yunnan Provincial Hospital of Infectious Diseases, Kunming.
authors.forename: Xingqi
authors.initials: X
authors.lastname: Dong
authors.affiliation: Center for Infectious Diseases, Beijing YouAn Hospital, Capital Medical University, China.
authors.forename: Tong
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Center for Infectious Diseases, Beijing YouAn Hospital, Capital Medical University, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Wu
authors.affiliation: University of California San Diego Veterans Affairs Healthcare System San Diego, California.
authors.forename: Davey M
authors.initials: DM
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D015331:Cohort Studies; D003140:Communicable Disease Control / Q000379:methods*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005838:Genotype; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission* / Q000821:virology; D015497:HIV-1 / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D017422:Sequence Analysis, DNA; D055815:Young Adult; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics
chemical_list: D054302:pol Gene Products, Human Immunodeficiency Virus
keywords: China; HIV; MSM; molecular epidemiology; targeted prevention