Human Immunodeficiency Virus (HIV)-1 Transmission Among Persons With Acute HIV-1 Infection in Malawi: Demographic, Behavioral, and Phylogenetic Relationships. (26th November 2018)

• Record Type: Journal Article
• Authors: Dennis, Ann M; Cohen, Myron S; Rucinski, Katherine B; Rutstein, Sarah E; Powers, Kimberly A; Pasquale, Dana K; Phiri, Sam; Hosseinipour, Mina C; Kamanga, Gift; Nsona, Dominic; Massa, Cecilia; Hoffman, Irving F; Pettifor, Audrey E; Miller, William C
• Is Part Of: Clinical infectious diseases. Volume 69:Number 5(2019)
• Page Start: 853
• Page End: 860
• Publication Date: 2018-11-26
• Subjects: molecular epidemiology -- HIV-1 -- phylogeny: transmission -- Malawi -- partner notification; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciy1006
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Understanding sexual networks involving acute human immunodeficiency virus (HIV)-1 infections (AHI) may lead to prevention opportunities to mitigate high rates of onward transmission. We evaluated HIV-1 phylogenetic and behavioral characteristics among persons with AHI and their referred partners. Methods: Between 2012 and 2014, 46 persons with AHI in Malawi participated in a combined behavioral and biomedical intervention. Participants referred sexual partners by passive referral. Demographics and sexual behaviors were collected through interviews and HIV-1 genetic relationships were assessed with phylogenetics. Results: Among 45 AHI participants with HIV-1 sequences, none was phylogenetically-linked with another AHI index. There were 19 (42%) AHI participants who referred a single partner that returned for testing. Most partners (n = 17) were HIV-infected, with 15 (88%) presenting with an established infection. There were 14 index-partner pairs that had sequences available; 13 (93%) pairs were phylogenetically-linked dyads. The AHI index was female in 7/13 (54%) dyads. Age-disparate relationships among dyads were common (≥5-year age difference in 67% of dyads), including 3/6 dyads involving a male index and a younger woman. Index participants with a referred partner were more likely to report no casual partners and to be living with their current partner than participants not in dyads. Conclusions: Passive-partner referral successfully identified partners with genetically-similar HIV infections—the likely source of infection—but only 40% of index cases referred partners who presented for HIV-1 testing. Future work evaluating assisted partner notification may help reach susceptible partners or more people with untreated HIV-1 infections connected to acute transmission. Clinical Trials Registration: NCT01450189 Abstract : Persons diagnosed with acute human immunodeficiency virus (HIV)-1 infection in Malawi had low recruitment of sexual partners through passive referrals. Nearly all successfully-recruited partners had established HIV-1 infections, and 93% of these had a phylogenetically-linked virus to the acute index.