Abstract
Using HIV sequence data to characterize clusters of HIV transmission may provide insight into the epidemic. Phylogenetic and network analyses were performed to infer putative relationships between HIV-1 partial pol sequences from 2,774 individuals receiving care in three German regions between 1999–2016. The regions have in common that they host some of the largest annual festivals in Europe (Carnival and Oktoberfest). Putative links with sequences (n = 150,396) from the Los Alamos HIV Sequence database were evaluated. A total of 595/2,774 (21.4%) sequences linked with at least one other sequence, forming 184 transmission clusters. Clustering individuals were significantly more likely to be younger, male, and report sex with men as their main risk factor (p < 0.001 each). Most clusters (77.2%) consisted exclusively of men; 41 (28.9%) of these included men reporting sex with women. Thirty-two clusters (17.4%) contained sequences from more than one region; clustering men were significantly more likely to be in a position bridging regional HIV epidemics than clustering women (p = 0.027). We found 236 clusters linking 547 sequences from our sample with sequences from the Los Alamos database (n = 1407; 31% from other German centres). These results highlight the pitfalls of focusing HIV prevention efforts on specific risk groups or specific locales.
Highlights
Melanie Stecher and Antoine Chaillon contributed to this work
Rates of recreational substance use and risky sex are high among visitors of large parties and festivals[16,17], all of which may contribute to bridging regional HIV epidemics within Germany and across Europe[18]
After correcting for representation, men were still more likely to be found in a position bridging regional HIV epidemics than women
Summary
Melanie Stecher and Antoine Chaillon contributed to this work. Joerg Janne Vehreschild and Martin Hoenigl jointly supervised this work. Rates of recreational substance use and risky sex are high among visitors of large parties and festivals[16,17], all of which may contribute to bridging regional HIV epidemics within Germany and across Europe[18]. Since the onset of universal drug resistance testing in Europe[19], viral sequence availability from HIV infected individuals has dramatically increased. These viral sequences can be used to infer transmission patterns among risk groups and geographical regions and evaluate the dynamics of these regional epidemics[20,21]. These analyses can reveal a more informative picture of the epidemic than standard measures of incidence and prevalence and can guide implementation of prevention measures on a local, national and international level[21,22,23]
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