title: HIV Transmission Patterns Among Immigrant Latinos Illuminated by the Integration of Phylogenetic and Migration Data.
abstract: Latinos represent a growing proportion of HIV cases in North Carolina (NC). Understanding how immigrants are involved in local HIV transmission is important to guide interventions. We used phylogenetics to characterize Latino involvement in local HIV transmission chains. Transmission clusters were identified from maximum-likelihood phylogenies constructed with HIV pol sequences from 177 Latinos and 1,496 non-Latinos receiving care in NC. Highly supported clusters involving one or more Latinos were characterized. Migration data were obtained from interviews and chart review. Factors associated with cluster membership were identified using log-binomial regression. Most Latinos were male (76%), immigrants (83%), and had HIV-1B (99%). Immigrants were more likely to report heterosexual risk (67% vs. 23%) than U.S.-born Latinos (p < 0.01). We identified 32 clusters that included one or more Latinos; these involved 53 Latinos (30%) and 41 non-Latinos. Immigrant and U.S.-born Latinos were equally likely to be in clusters, but immigrants were more likely to be in clusters with another Latino (78% vs. 29%; p = 0.02). Cluster composition by ethnicity and risk behavior varied by cluster size; larger clusters contained fewer immigrants and more men who have sex with men (MSM). Factors associated with immigrant membership in local transmission clusters included age <30 years [RR 2.34 (95% CI 1.47-3.73)], Mexican origin [RR 2.55 (95% CI 1.29-6.88)], and residing in the United States longer before diagnosis [RR 1.53 (95% CI 1.09-2.15), per 10 years]. While some Latinos immigrate with HIV infection, many immigrants are involved in transmission networks after arrival, particularly MSM. HIV testing and prevention interventions must consider this heterogeneity and may be better targeted by integrating phylogenetic analyses.
authors.affiliation: 1 Division of Infectious Diseases, School of Medicine, University of North Carolina , Chapel Hill, North Carolina.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Dennis
authors.affiliation: 2 Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , London, United Kingdom .
authors.forename: Stéphane
authors.initials: S
authors.lastname: Hué
authors.affiliation: 3 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina , Chapel Hill, North Carolina.
authors.forename: Dana
authors.initials: D
authors.lastname: Pasquale
authors.affiliation: 1 Division of Infectious Diseases, School of Medicine, University of North Carolina , Chapel Hill, North Carolina.|3 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina , Chapel Hill, North Carolina.
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.affiliation: 4 Laboratory Corporation of America, Research Triangle Park , North Carolina.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sebastian
authors.affiliation: 1 Division of Infectious Diseases, School of Medicine, University of North Carolina , Chapel Hill, North Carolina.|3 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina , Chapel Hill, North Carolina.
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.affiliation: 1 Division of Infectious Diseases, School of Medicine, University of North Carolina , Chapel Hill, North Carolina.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005260:Female; D005838:Genotype; D006678:HIV / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D015658:HIV Infections / Q000635:transmission* / Q000821:virology*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D017720:Molecular Epidemiology; D010802:Phylogeny; D012309:Risk-Taking; D017422:Sequence Analysis, DNA; D012725:Sexual Behavior; D014481:United States / Q000453:epidemiology; D055815:Young Adult; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics
chemical_list: D054302:pol Gene Products, Human Immunodeficiency Virus