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

doi:10.1093/infdis/jiv758

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

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Research output: Contribution to journal › Article › peer-review

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Abstract

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 language	English
Pages (from-to)	1410-1418
Number of pages	9
Journal	Journal of Infectious Diseases
Volume	213
Issue number	9
DOIs	https://doi.org/10.1093/infdis/jiv758
Publication status	Published - 1 May 2016

Bibliographical note

Funding Information:
This work was supported by the Pangea-HIV Consortium, which is supported by the Bill & Melinda Gates Foundation; the Biotechnology and Biological Science Research Council, and the National Institutes of Health (GM110749); the United Kingdom Medical Research Council (award 164587 to the United Kingdom HIV Drug Resistance Database); the United Kingdom Department of Health; Boehringer Ingelheim (to the United Kingdom HIV Drug Resistance Database); Bristol-Myers Squibb (to the United Kingdom HIV Drug Resistance Database); Gilead (to the United Kingdom HIV Drug Resistance Database); Tibotec (a division of Janssen-Cilag; to the United Kingdom HIV Drug Resistance Database); and Roche (to the United Kingdom HIV Drug Resistance Database).

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

Keywords

HIV
MSM
PWID
clusters
crossover
epidemiology
heterosexual
phylogenetics
phylogeny
subtypes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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

abstract = "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.",

keywords = "HIV, MSM, PWID, clusters, crossover, epidemiology, heterosexual, phylogenetics, phylogeny, subtypes",

author = "Manon Ragonnet-Cronin and Lycett, {Samantha J.} and Hodcroft, {Emma B.} and Stphane Hu{\'e} and Esther Fearnhill and Brown, {Alison E.} and Valerie Delpech and David Dunn and {Leigh Brown}, {Andrew J.}",

note = "Funding Information: This work was supported by the Pangea-HIV Consortium, which is supported by the Bill & Melinda Gates Foundation; the Biotechnology and Biological Science Research Council, and the National Institutes of Health (GM110749); the United Kingdom Medical Research Council (award 164587 to the United Kingdom HIV Drug Resistance Database); the United Kingdom Department of Health; Boehringer Ingelheim (to the United Kingdom HIV Drug Resistance Database); Bristol-Myers Squibb (to the United Kingdom HIV Drug Resistance Database); Gilead (to the United Kingdom HIV Drug Resistance Database); Tibotec (a division of Janssen-Cilag; to the United Kingdom HIV Drug Resistance Database); and Roche (to the United Kingdom HIV Drug Resistance Database). Publisher Copyright: {\textcopyright} 2016 The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America.",

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doi = "10.1093/infdis/jiv758",

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T1 - Transmission of Non-B HIV Subtypes in the United Kingdom Is Increasingly Driven by Large Non-Heterosexual Transmission Clusters

AU - Ragonnet-Cronin, Manon

AU - Lycett, Samantha J.

AU - Hodcroft, Emma B.

AU - Hué, Stphane

AU - Fearnhill, Esther

AU - Brown, Alison E.

AU - Delpech, Valerie

AU - Dunn, David

AU - Leigh Brown, Andrew J.

N1 - Funding Information: This work was supported by the Pangea-HIV Consortium, which is supported by the Bill & Melinda Gates Foundation; the Biotechnology and Biological Science Research Council, and the National Institutes of Health (GM110749); the United Kingdom Medical Research Council (award 164587 to the United Kingdom HIV Drug Resistance Database); the United Kingdom Department of Health; Boehringer Ingelheim (to the United Kingdom HIV Drug Resistance Database); Bristol-Myers Squibb (to the United Kingdom HIV Drug Resistance Database); Gilead (to the United Kingdom HIV Drug Resistance Database); Tibotec (a division of Janssen-Cilag; to the United Kingdom HIV Drug Resistance Database); and Roche (to the United Kingdom HIV Drug Resistance Database). Publisher Copyright: © 2016 The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America.

PY - 2016/5/1

Y1 - 2016/5/1

N2 - 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.

AB - 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.

KW - HIV

KW - MSM

KW - PWID

KW - clusters

KW - crossover

KW - epidemiology

KW - heterosexual

KW - phylogenetics

KW - phylogeny

KW - subtypes

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SN - 0022-1899

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EP - 1418

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

IS - 9

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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