Abstract
BackgroundThe proportion of older HIV-1 infected people in China has increased rapidly in recent years. Elucidation of the transmission characteristics of this high-risk population subgroup is helpful for the development of tailored interventions.MethodsA phylogenetic analysis was performed that uses available HIV-1 pol sequences amplified with nested RT-PCR from plasma samples of all newly diagnosed participants spanning from October 2017 to September 2018 in Fuyang, Anhui Province. Transmission clusters were identified as two or more sequences that shared a corresponding node with an aLRT-SH value ≥90 in the maximum-likelihood phylogenetic tree and had an overall mean genetic distance of ≤1.5%. A local transmission cluster was defined as a cluster that had more than 80% of its sequences from Fuyang. The role of older people in local HIV-1 transmission was determined using an integration of molecular and demographic data.ResultsOf 362 available sequences, 14 subtypes, and 28 local transmission clusters were identified. It was found that the proportion of older people in the local transmission cluster (69/77, 89.61%) was much higher than that of younger people (46/114, 40.35%) (χ2 test, P < 0.001). In the pretreatment drug resistance analysis, the proportion of sequences with PDRMs in the local transmission cluster was not significantly different between the older people group (57.14%, 4/7) and non-old-aged group (11.11%, 1/9) (Fisher’s exact test, P > 0.05).ConclusionBy combining phylogenetic analyses with demographic data, more detailed information was provided about the local transmission structure in Fuyang. These findings suggested that older people play an important role in local transmission, and more tailored interventions for this population subgroup are urgently needed.
Highlights
The proportion of older human immunodeficiency viruses (HIV)-1 infected people in China has increased rapidly in recent years
In reference to the transmission category, as many as 60.66% (202/333) of HIV-1 infected cases acquired the virus by heterosexual contact, 38.44% (128/333) of HIV-1 infected cases were men who have sex with men (MSM), 0.3% (1/333) were infected by injection drug use or heterosexual contact, 0.3% (1/333) were injecting drug users (IDUs), and 0.3% (1/333) of cases had an unknown transmission category
Older people were more likely to be infected through heterosexual contact (113/ 126, 89.68%), in contrast, the proportion of MSM (117/ 207, 56.52%) was higher than whom infected through heterosexual contact (89/207, 43.00%) in non-old aged group
Summary
The proportion of older HIV-1 infected people in China has increased rapidly in recent years. When HIV has become a manageable chronic disease, older people living with HIV, Wu et al BMC Infectious Diseases (2019) 19:562 of older people newly diagnosed with HIV-1 infection increased in recent years in some areas of China [8, 9]. By 2014, a total of 3521 HIV-1 infected cases (486 HIV infections, 1917 AIDS cases and 1118 deaths) had been reported, and the HIV prevalence was 0.031% (2403/7,823,000) This survey highlighted that the proportion of older newly HIV-1 infections rapidly increased from 19.0 to 32.1% in 2009– 2014, though the proportion of local older people in Fuyang which had a residential population of 7.6–8.4 million has stabilized at 23% on average and didn’t change significantly in last decade. Elucidation of the transmission characteristics of this high-risk population subgroup is helpful for the development of tailored interventions
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