HIV-1 Transmission During Recent Infection and During Treatment Interruptions as Major Drivers of New Infections in the Swiss HIV Cohort Study

Marzel, A. and Shilaih, M. and Yang, W. L. and Boni, J. and Yerly, S. and Klimkait, T. and Aubert, V. and Braun, D. L. and Calmy, A. and Furrer, H. and Cavassini, M. and Battegay, M. and Vernazza, P. L. and Bernasconi, E. and Gunthard, H. F. and Kouyos, R. D. and Swiss, H. I. V. Cohort Study and Aubert, V. and Battegay, M. and Bernasconi, E. and Boni, J. and Bucher, H. C. and Burton-Jeangros, C. and Calmy, A. and Cavassini, M. and Dollenmaier, G. and Egger, M. and Elzi, L. and Fehr, J. and Fellay, J. and Furrer, H. and Fux, C. A. and Gorgievski, M. and Gunthard, H. F. and Haerry, D. and Hasse, B. and Hirsch, H. H. and Hoffmann, M. and Hosli, I. and Kahlert, C. and Kaiser, L. and Keiser, O. and Klimkait, T. and Kouyos, R. D. and Kovari, H. and Ledergerber, B. and Martinetti, G. and de Tejada, B. M. and Metzner, K. and Muller, N. and Nadal, D. and Nicca, D. and Pantaleo, G. and Rauch, A. and Regenass, S. and Rickenbach, M. and Rudin, C. and Schoni-Affolter, F. and Schmid, P. and Schupbach, J. and Speck, R. and Tarr, P. and Trkola, A. and Vernazza, P. L. and Weber, R. and Yerly, S.. (2016) HIV-1 Transmission During Recent Infection and During Treatment Interruptions as Major Drivers of New Infections in the Swiss HIV Cohort Study. Clin Infect Dis, 62 (1). pp. 115-122.

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Official URL: https://edoc.unibas.ch/61882/

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BACKGROUND: Reducing the fraction of transmissions during recent human immunodeficiency virus (HIV) infection is essential for the population-level success of "treatment as prevention". METHODS: A phylogenetic tree was constructed with 19 604 Swiss sequences and 90 994 non-Swiss background sequences. Swiss transmission pairs were identified using 104 combinations of genetic distance (1%-2.5%) and bootstrap (50%-100%) thresholds, to examine the effect of those criteria. Monophyletic pairs were classified as recent or chronic transmission based on the time interval between estimated seroconversion dates. Logistic regression with adjustment for clinical and demographic characteristics was used to identify risk factors associated with transmission during recent or chronic infection. FINDINGS: Seroconversion dates were estimated for 4079 patients on the phylogeny, and comprised between 71 (distance, 1%; bootstrap, 100%) to 378 transmission pairs (distance, 2.5%; bootstrap, 50%). We found that 43.7% (range, 41%-56%) of the transmissions occurred during the first year of infection. Stricter phylogenetic definition of transmission pairs was associated with higher recent-phase transmission fraction. Chronic-phase viral load area under the curve (adjusted odds ratio, 3; 95% confidence interval, 1.64-5.48) and time to antiretroviral therapy (ART) start (adjusted odds ratio 1.4/y; 1.11-1.77) were associated with chronic-phase transmission as opposed to recent transmission. Importantly, at least 14% of the chronic-phase transmission events occurred after the transmitter had interrupted ART. CONCLUSIONS: We demonstrate a high fraction of transmission during recent HIV infection but also chronic transmissions after interruption of ART in Switzerland. Both represent key issues for treatment as prevention and underline the importance of early diagnosis and of early and continuous treatment.
Faculties and Departments:03 Faculty of Medicine > Departement Biomedizin > Division of Medical Microbiology > Molecular Virology (Klimkait)
03 Faculty of Medicine > Departement Biomedizin > Division of Medical Microbiology > Transplantation Virology (Hirsch)
UniBasel Contributors:Hirsch, Hans H. and Klimkait, Thomas
Item Type:Article, refereed
Article Subtype:Research Article
ISSN:1537-6591 (Electronic)1058-4838 (Linking)
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:31 May 2020 21:21
Deposited On:31 May 2020 21:21

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