Infection, Genetics and Evolution
Volume 61, 2018, Pages 36-44

Phylogenetic analysis of the Belgian HIV-1 epidemic reveals that local transmission is almost exclusively driven by men having sex with men despite presence of large African migrant communities (Article) (Open Access)

Verhofstede C.* , Dauwe K. , Fransen K. , Van Laethem K. , Van den Wijngaert S. , Ruelle J. , Delforge M.-L. , Vancutsem E. , Vaira D. , Stoffels K. , Ribas S.G. , Dessilly G. , Debaisieux L. , Pierard D. , Van Ranst M. , Hayette M.-P. , Deblonde J. , Sasse A. , Van Beckhoven D. , Mortier V.
  • a Aids Reference Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium
  • b Aids Reference Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium
  • c HIV/STD Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
  • d Department of Microbiology and Immunology, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium, Aids Reference Laboratory, University Hospitals Leuven, Leuven, Belgium
  • e Aids Reference Laboratory, Centre Hospitalier Universitaire St. Pierre, Brussels, Belgium
  • f Aids Reference Laboratory, Medical Microbiology Unit, Université Catholique de Louvain, Brussels, Belgium
  • g Aids Reference Laboratory, Université Libre de Bruxelles, Brussels, Belgium
  • h Aids Reference Laboratory, Vrije Universiteit Brussel VUB, Brussels, Belgium
  • i Aids Reference Laboratory, Centre Hospitalier Universitaire de Liège, Liège, Belgium
  • j Aids Reference Laboratory, Centre Hospitalier Universitaire St. Pierre, Brussels, Belgium
  • k HIV/STD Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
  • l Aids Reference Laboratory, Medical Microbiology Unit, Université Catholique de Louvain, Brussels, Belgium
  • m Aids Reference Laboratory, Université Libre de Bruxelles, Brussels, Belgium
  • n Aids Reference Laboratory, Vrije Universiteit Brussel VUB, Brussels, Belgium
  • o Department of Microbiology and Immunology, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium, Aids Reference Laboratory, University Hospitals Leuven, Leuven, Belgium
  • p Aids Reference Laboratory, Centre Hospitalier Universitaire de Liège, Liège, Belgium
  • q Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Anderlecht, Belgium
  • r Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Anderlecht, Belgium
  • s Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Anderlecht, Belgium
  • t Aids Reference Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium

Abstract

To improve insight in the drivers of local HIV-1 transmission in Belgium, phylogenetic, demographic, epidemiological and laboratory data from patients newly diagnosed between 2013 and 2015 were combined and analyzed. Characteristics of clustered patients, paired patients and patients on isolated branches in the phylogenetic tree were compared. The results revealed an overall high level of clustering despite the short time frame of sampling, with 47.6% of all patients having at least one close genetic counterpart and 36.6% belonging to a cluster of 3 or more individuals. Compared to patients on isolated branches, patients in clusters more frequently reported being infected in Belgium (95.1% vs. 47.6%; p < 0.001), were more frequently men having sex with men (MSM) (77.9% vs. 42.8%; p < 0.001), of Belgian origin (68.2% vs. 32.9%; p < 0.001), male gender (92.6% vs. 65.8%; p < 0.001), infected with subtype B or F (87.8% vs. 43.4%; p < 0.001) and diagnosed early after infection (55.4% vs. 29.0%; p < 0.001). Strikingly, Sub-Saharan Africans (SSA), overall representing 27.1% of the population were significantly less frequently found in clusters than on individual branches (6.0% vs. 41.8%; p < 0.001). Of the SSA that participated in clustered transmission, 66.7% were MSM and this contrasts sharply with the overall 12.0% of SSA reporting MSM. Transmission clusters with SSA were more frequently non-B clusters than transmission clusters without SSA (44.4% versus 18.2%). MSM-driven clusters with patients of mixed origin may account, at least in part, for the increasing spread of non-B subtypes to the native MSM population, a cross-over that has been particularly successful for subtype F and CRF02_AG. The main conclusions from this study are that clustered transmission in Belgium remains almost exclusively MSM-driven with very limited contribution of SSA. There were no indications for local ongoing clustered transmission of HIV-1 among SSA. © 2018 The Authors

Author Keywords

Men who have sex with men HIV-1 transmission HIV-1 in Belgium HIV-1 in Sub-Saharan African migrants Phylogenetic clustering

Index Keywords

genetics HIV Infections Africa south of the Sahara transmission Human immunodeficiency virus infection demography human sex difference risk assessment middle aged statistics and numerical data controlled study priority journal nonhuman African men who have sex with men Homosexuality, Male male homosexuality nucleotide sequence epidemiological data cluster analysis population risk Humans migrant virology male female risk factor Belgium Article disease transmission major clinical study Phylogeny adult migration HIV-1 infection risk virus load Human immunodeficiency virus 1 infection age distribution Human immunodeficiency virus 1 Transients and Migrants
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85043754669&doi=10.1016%2fj.meegid.2018.03.002&partnerID=40&md5=c4c4f547189c3eb0d97a508528574db4
DOI: 10.1016/j.meegid.2018.03.002
ISSN: 15671348
Cited by: 5
Original Language: English