Molecular epidemiology of HIV-1 subtype B reveals heterogeneous transmission risk: Implications for intervention and control

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Title: Molecular epidemiology of HIV-1 subtype B reveals heterogeneous transmission risk: Implications for intervention and control
Authors: Volz, E
Le Vu, S
Ratmann, O
Tostevin, A
Orkin, C
O'Shea, S
Delpech, V
Brown, A
Fraser, NGC
Item Type: Journal Article
Abstract: Background The impact of HIV pre-exposure prophylaxis (PrEP) depends on infections averted by protecting vulnerable individuals as well as infections averted by preventing transmission by those who would have been infected if not receiving PrEP. Analysis of HIV phylogenies reveals risk factors for transmission, which we examine as potential criteria for allocating PrEP. Methods We analyzed 6912 HIV-1 partial pol sequences from men who have sex with men (MSM) in the United Kingdom combined with global reference sequences and patient-level metadata. Population genetic models were developed that adjust for stage of infection, global migration of HIV lineages, and changing incidence of infection through time. Models were extended to simulate the effects of providing susceptible MSM with PrEP. Results We found that young age <25 years confers higher risk of HIV transmission (relative risk = 2.52 [95% confidence interval, 2.32–2.73]) and that young MSM are more likely to transmit to one another than expected by chance. Simulated interventions indicate that 4-fold more infections can be averted over 5 years by focusing PrEP on young MSM. Conclusions Concentrating PrEP doses on young individuals can avert more infections than random allocation.
Issue Date: 23-Apr-2018
Date of Acceptance: 22-Jan-2018
ISSN: 0022-1899
Publisher: Oxford University Press (OUP)
Start Page: 1522
End Page: 1529
Journal / Book Title: Journal of Infectious Diseases
Volume: 217
Issue: 10
Copyright Statement: © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: Medical Research Council (MRC)
National Institutes of Health
Funder's Grant Number: MR/K010174/1B
Keywords: UK HIV Drug Resistance Database
11 Medical And Health Sciences
06 Biological Sciences
Publication Status: Published
Open Access location:
Online Publication Date: 2018-02-26
Appears in Collections:Mathematics
Faculty of Natural Sciences
School of Public Health

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