title: Phylogenetic evidence for underreporting of male-to-male sex among human immunodeficiency virus-infected donors in the Netherlands and Flanders.
abstract: Separate transmission networks for human immunodeficiency virus (HIV) coexist. Molecular typing of viral genomes can provide insight in HIV transmission routes in donors for whom risk behavior-based donor selection failed.
  
  
  
  This study includes all HIV-infected Dutch and Flemish donors in the period 2005 to 2014 (n = 55). Part of the HIV polymerase (pol) gene was amplified, sequenced, and compared with more than 10,000 HIV strains obtained from HIV-infected Dutch and Flemish patients. The most likely transmission route was determined based on HIV phylogeny and the donor's self-reported risk behavior during the exit interview.
  
  
  
  HIV-infected donors were predominantly male (69%), were repeat donors (73%), were born in the Netherlands or Belgium (95%), and harbored HIV Subtype B (68%). Seventy-five percent of HIV-infected male donors were part of robust phylogenetic clusters linked to male-to-male sex, while only 24% of HIV-infected male donors reported male-to-male sex during posttest counseling. Sex between men and women accounted for 13% of HIV infections in male donors and 93% of HIV infections in female donors based on phylogenetic analysis. Only 40% of HIV-infected female donors had HIV Subtype B; 65% of female donors reported a foreign partner and indeed HIV sequences interspersed with sequences from HIV-endemic areas abroad, in particular sub-Saharan Africa.
  
  
  
  HIV typing helps to understand HIV transmission routes in donor populations. We found substantial underreporting of male-to-male sex among HIV-infected male donors. Donor education on HIV risk factors and the danger of window-period donations and a donor environment that encourages frank disclosure of sexual behavior will contribute to a decrease of HIV-infected donors.
authors.affiliation: Department of Blood-borne Infections, Sanquin Research, Amsterdam, the Netherlands.
authors.forename: Thijs J
authors.initials: TJ
authors.lastname: van de Laar
authors.affiliation: Stichting HIV Monitoring, Amsterdam, the Netherlands.
authors.forename: Daniela
authors.initials: D
authors.lastname: Bezemer
authors.affiliation: Laboratory for Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven-Leuven University, Leuven, Belgium.|AIDS Reference Laboratory, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Kristel
authors.initials: K
authors.lastname: van Laethem
authors.affiliation: Blood Service, Belgian Red Cross-Flanders, Mechelen, Belgium.
authors.forename: Giovani
authors.initials: G
authors.lastname: Vandewalle
authors.affiliation: Blood Service, Belgian Red Cross-Flanders, Mechelen, Belgium.
authors.forename: Annie
authors.initials: A
authors.lastname: de Smet
authors.affiliation: AIDS Reference Center, University Hospitals Leuven, Leuven, Belgium.|Laboratory for Clinical Infectious and Inflammatory Disorders, Department of Microbiology and Immunology, KU Leuven-Leuven University, Leuven, Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: van Wijngaerden
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Centre, Leiden, the Netherlands.|Department of Molecular Biology, MC Slotervaart, Amsterdam, the Netherlands.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Claas
authors.affiliation: Stichting HIV Monitoring, Amsterdam, the Netherlands.
authors.forename: Ard I
authors.initials: AI
authors.lastname: van Sighem
authors.affiliation: Laboratory for Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven-Leuven University, Leuven, Belgium.|Center for Global Health and Tropical Medicine, Microbiology Unit, Institute for Hygiene and Tropical Medicine, University Nova de Lisboa, Lisbon, Portugal.
authors.forename: Anne-Mieke
authors.initials: AM
authors.lastname: Vandamme
authors.affiliation: Blood Service, Belgian Red Cross-Flanders, Mechelen, Belgium.|Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors.forename: Veerle
authors.initials: V
authors.lastname: Compernolle
authors.affiliation: Department of Blood-borne Infections, Sanquin Research, Amsterdam, the Netherlands.|Department of Medical Microbiology (CINIMA), Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Hans L
authors.initials: HL
authors.lastname: Zaaijer
mesh_terms: D001530:Belgium; D001782:Blood Donors; D018563:Disease Notification / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010802:Phylogeny; D057566:Self Report; D012725:Sexual Behavior; D012747:Sexual Partners; D000072339:Sexual and Gender Minorities