Phylogenetic insights into HIV transmission in North Carolina.

AIDS, 2012

Abstract OBJECTIVES: Despite prevention efforts new HIV diagnoses continue in the Southern US, where the epidemic is characterized by significant racial/ethnic disparities.
DESIGN: Cross-sectional analysis of 1671 HIV-infected individuals each with one B-subtype pol sequence obtained during chronic (82%; UNC Center for AIDS Research Clinical Cohort) or acute/recent (18%; Duke/UNC Acute HIV Consortium) infection.
METHODS: Phylogenies were inferred using neighbor joining to select related sequences then confirmed with Bayesian methods.
We characterized transmission clusters (clades n≥3 sequences supported by posterior probabilities=1) by factors including race/ethnicity and transmission risk.
A total of 557 (33%) sequences grouped in either 108 pairs (n = 216) or 67 clusters (n = 341).
Composition was delineated primarily by race,with 28%exclusively black, and to a lesser extent by risk group.
In multivariable analysis, patients with age ≤30 years (P = 0.009), acute infection (P = 0.02), local residence (P = 0.002), and transmitted drug resistance (P = 0.02) were more likely to be cluster members while Latinos were less likely (P < 0.001).
CONCLUSIONS: Integration of molecular, clinical and demographic data offers a unique view into the structure of local transmission networks.
Clustering by black race, youth and TDR and inability to identify Latino clusters will inform prevention, testing and linkage to care strategies.
HIV infection in men who have sex with men, New York City Department of Health sexually transmitted disease clinics, 1990-1999: a decade of serosurveillance finds that racial disparities and associations between HIV and gonorrhea persist.