title: Using Molecular HIV Surveillance Data to Understand Transmission Between Subpopulations in the United States.
abstract: BACKGROUND
  Studying HIV transmission networks provides insight into the spread of HIV and opportunities for intervention. We identified transmission dynamics among risk groups and racial/ethnic groups in the United States.
  
  
  METHODS
  For HIV-1 pol sequences reported to the US National HIV Surveillance System during 2001-2012, we calculated pairwise genetic distance, identified linked pairs of sequences (those with distance ≤1.5%), and examined transmission category and race/ethnicity of these potential transmission partners.
  
  
  RESULTS
  Of 40,950 sequences, 12,910 (32%) were linked to ≥1 other sequence. Of men who have sex with men (MSM) who were linked to ≥1 sequence, 88% were linked to other MSM and only 4% were linked to heterosexual women. Of heterosexual women for whom we identified potential transmission partners, 29% were linked to MSM, 21% to heterosexual men, and 12% to persons who inject drugs. Older and black MSM were more likely to be linked to heterosexual women. Assortative mixing was present for all racial/ethnic groups; 81% of blacks/African Americans linked to other blacks.
  
  
  CONCLUSIONS
  This analysis is the first use of US surveillance data to infer an HIV transmission network. Our data suggest that HIV infections among heterosexual women predominantly originate from MSM, followed by heterosexual men. Although few MSM were linked to women, suggesting that a minority of MSM are involved in transmission with heterosexual women, these transmissions represent a substantial proportion of HIV acquisitions by heterosexual women. Interventions that reduce transmissions involving MSM are likely to also reduce HIV acquisition among other risk groups.
authors: *Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA; †ICF International, Atlanta, GA; and ‡Department of Medicine, University of California, San Diego, CA.
authors: Alexandra M
authors: AM
authors: Oster
authors: Joel O
authors: JO
authors: Wertheim
authors: Angela L
authors: AL
authors: Hernandez
authors: Marie Cheryl Bañez
authors: MC
authors: Ocfemia
authors: Neeraja
authors: N
authors: Saduvala
authors: H Irene
authors: HI
authors: Hall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D018562:Disease Transmission, Infectious; D062665:Epidemiological Monitoring; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D015497:HIV-1 / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology / Q000379:methods; D017422:Sequence Analysis, DNA; D017385:Sequence Homology; D012747:Sexual Partners; 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