Abstract
The Human immunodeficiency virus type-1 (HIV-1) epidemic in the Caribbean region is mostly driven by subtype B; but information about the pattern of viral spread in this geographic region is scarce and different studies point to quite divergent models of viral dissemination. In this study, we reconstructed the spatiotemporal and population dynamics of the HIV-1 subtype B epidemic in the Caribbean. A total of 1,806 HIV-1 subtype B pol sequences collected from 17 different Caribbean islands between 1996 and 2011 were analyzed together with sequences from the United States (n = 525) and France (n = 340) included as control. Maximum Likelihood phylogenetic analyses revealed that HIV-1 subtype B infections in the Caribbean are driven by dissemination of the pandemic clade (BPANDEMIC) responsible for most subtype B infections across the world, and older non-pandemic lineages (BCAR) characteristics of the Caribbean region. The non-pandemic BCAR strains account for >40% of HIV-1 infections in most Caribbean islands; with exception of Cuba and Puerto Rico. Bayesian phylogeographic analyses indicate that BCAR strains probably arose in the island of Hispaniola (Haiti/Dominican Republic) around the middle 1960s and were later disseminated to Trinidad and Tobago and to Jamaica between the late 1960s and the early 1970s. In the following years, the BCAR strains were also disseminated from Hispaniola and Trinidad and Tobago to other Lesser Antilles islands at multiple times. The BCAR clades circulating in Hispaniola, Jamaica and Trinidad and Tobago appear to have experienced an initial phase of exponential growth, with mean estimated growth rates of 0.35–0.45 year−1, followed by a more recent stabilization since the middle 1990s. These results demonstrate that non-pandemic subtype B lineages have been widely disseminated through the Caribbean since the late 1960s and account for an important fraction of current HIV-1 infections in the region.
Highlights
An estimated 34 million people were infected with the human immunodeficiency virus-type 1 (HIV-1), the aetiologic agent of acquired immunodeficiency syndrome (AIDS), at the end of 2012 [1]
This analysis revealed that BCAR sequences from the Dominican Republic and Haiti, two nations located in the island of Hispaniola, were highly intermixed with each other and occupied the deepest branches in the subtype B phylogeny; whereas most BCAR sequences from Jamaica and Trinidad and Tobago branched in two country-specific subclades, BCAR-JM and BCAR-TT, that were nested among basal sequences from Hispaniola (Fig. 1A)
In order to obtain more accurate estimates of the prevalence of BPANDEMIC and BCAR clades in the Caribbean region, we performed a second Maximum Likelihood (ML) analysis that combined shorter subtype B pol (RT) Caribbean sequences (n = 1,063) from countries poorly represented in the partial reverse transcriptase (PR/RT) dataset (Barbados, Guadeloupe, Haiti, Martinique, Puerto Rico and United States (US) Virgin Islands) with reference sequences representative of the BPANDEMIC (US/France = 300) and BCAR (Caribbean = 200) clades selected from the previous analysis
Summary
An estimated 34 million people were infected with the human immunodeficiency virus-type 1 (HIV-1), the aetiologic agent of acquired immunodeficiency syndrome (AIDS), at the end of 2012 [1]. About 250,000 people (1.0% of the adult population) were living with HIV-1 in the Caribbean in 2012, 78% of whom were reported in Hispaniola, the island shared by the Dominican Republic and Haiti [1]. HIV prevalence greatly varies among countries ranging from ,0.1% in Cuba to over 2% in the Bahamas and Haiti [1]. The first AIDS cases were recognized in Haiti in 1978–1979 [2] and in other Caribbean countries in 1982–1984 [3,4,5]. The main mode of HIV transmission in the region is heterosexual sex [6]
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