Transmission of Non-B HIV Subtypes in the United Kingdom Is Increasingly Driven by Large Non-Heterosexual Transmission Clusters

Manon Ragonnet-Cronin, Samantha J. Lycett, Emma B. Hodcroft, Stphane Hué, Esther Fearnhill, Alison E. Brown, Valerie Delpech, David Dunn, Andrew J. Leigh Brown*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

46 Citations (Scopus)


Background. The United Kingdom human immunodeficiency virus (HIV) epidemic was historically dominated by HIV subtype B transmission among men who have sex with men (MSM). Now 50% of diagnoses and prevalent infections are among heterosexual individuals and mainly involve non-B subtypes. Between 2002 and 2010, the prevalence of non-B diagnoses among MSM increased from 5.4% to 17%, and this study focused on the drivers of this change. Methods. Growth between 2007 and 2009 in transmission clusters among 14 000 subtype A1, C, D, and G sequences from the United Kingdom HIV Drug Resistance Database was analysed by risk group. Results. Of 1148 clusters containing at least 2 sequences in 2007, >75% were pairs and >90% were heterosexual. Most clusters (71.4%) did not grow during the study period. Growth was significantly lower for small clusters and higher for clusters of ≥7 sequences, with the highest growth observed for clusters comprising sequences from MSM and people who inject drugs (PWID). Risk group (P <. 0001), cluster size (P <. 0001), and subtype (P <. 01) were predictive of growth in a generalized linear model. Discussion. Despite the increase in non-B subtypes associated with heterosexual transmission, MSM and PWID are at risk for non-B infections. Crossover of subtype C from heterosexuals to MSM has led to the expansion of this subtype within the United Kingdom.

Original languageEnglish
Pages (from-to)1410-1418
Number of pages9
JournalJournal of Infectious Diseases
Issue number9
Publication statusPublished - 1 May 2016

Bibliographical note

Publisher Copyright:
© 2016 The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America.


  • HIV
  • MSM
  • PWID
  • clusters
  • crossover
  • epidemiology
  • heterosexual
  • phylogenetics
  • phylogeny
  • subtypes


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