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- Title
Human Immunodeficiency Virus (HIV)-1 Transmission Among Persons With Acute HIV-1 Infection in Malawi: Demographic, Behavioral, and Phylogenetic Relationships.
- 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
- 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
- Subjects
MALAWI; HIV infection genetics; HIV prevention; HIV infection transmission; PREVENTION of sexually transmitted diseases; SEXUALLY transmitted disease risk factors; VIRAL disease prevention; AGE distribution; BEHAVIOR therapy; COMBINED modality therapy; HIV; PSYCHOLOGY of HIV-positive persons; INTERVIEWING; MEDICAL referrals; PHYLOGENY; RISK-taking behavior; HUMAN sexuality; VIRUS diseases; PSYCHOSOCIAL factors; CONTACT tracing; SEXUAL partners; SEQUENCE analysis
- Publication
Clinical Infectious Diseases, 2019, Vol 69, Issue 5, p853
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciy1006