O19.4 Molecular epidemiology of HIV among foreign-born residents of king county, washington, USA, using HIV surveillance data. (14th July 2019)

• Record Type: Journal Article
• Authors: Tordoff, Diana; Herbeck, Joshua; Buskin, Susan; Lechtenberg, Richard; Golden, Matthew; Kerani, Roxanne
• Is Part Of: Sexually transmitted infections. Volume 95(2019)Supplement 1
• Page Start: A83
• Page End: A83
• Publication Date: 2019-07-14
• Subjects: HIV; Sexually transmitted diseases -- Periodicals; HIV infections -- Periodicals; 616.951005
• DOI: 10.1136/sextrans-2019-sti.213
• Languages: English
• ISSNs: 1368-4973

Abstract

Abstract : Background: In King County, one-third of HIV diagnoses occur among foreign-born individuals, a 50% increase since 2010. The extent to which these infections are locally acquired is unclear, but has important implications for HIV prevention and incidence estimation. Methods: Using HIV surveillance (2010–2018) and partner services (PS) (2010–2016) data from Public Health–Seattle & King County, HIV-1 pol gene sequences from routine drug resistance testing were linked to demographic, clinical, and epidemiological information. We identified genetic similarity clusters of 2+ individuals using TN93 pairwise genetic distance with a 0.02 threshold. Belonging to a cluster is suggestive of local transmission, therefore correlates of clustering were identified using logistic regression, adjusted for early infection (CD4 >500 cells/mm at diagnosis). We also calculated the proportion of foreign-born cases with a negative HIV test in the U.S. before diagnosis. Results: From 2010–2018, 2, 521 people were diagnosed with HIV in King County: 663 (26%) occurred among foreign-born individuals, primarily from Latin America (N=232), sub-Saharan Africa (SSA) (N=214), and Asia (N=98). Among individuals with a PS interview (75% Latin American, 56% SSA, 69% Asian-born), HIV testing histories suggest that 40% of Latin American, 19% of SSA, and 36% of Asian-born individuals likely acquired HIV locally. Individuals with non-B HIV subtypes similarly varied by region of birth: 2% of US, 5% of Latin American, 93% of SSA, and 46% of Asian-born people. Among 1, 754 individuals with an available sequence (70% of U.S. versus 63% of foreign-born), 1, 092 (62%) clustered in 304 genetically similar clusters. Odds of clustering, compared to US-born, was 0.44 (95%CI: 0.31, 0.60) among Latin American, 0.08 (95%CI: 0.05, 0.14) among SSA, and 0.40 (95%CI: 0.24, 0.66) among Asian-born. Conclusion: Our results suggest that local HIV acquisition occurs least frequently among SSA-born, followed by Asian-born and Latin American immigrants. Incident estimates that include all diagnoses among foreign-born people may overestimate HIV incidence. Disclosure: No significant relationships.