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Using phylogenetics of HIV to inform prevention among young black men who have sex with men in Chicago - HIV Transmission Clusters Offer Clues to HIV Risk in Young Black MSM
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21st International AIDS Conference (AIDS 2016), July 18-22, 2016, Durban, South Africa
Mark Mascolini
Phylogenetic analysis of young black men who have sex with men (MSM) in Chicago confirmed high connectivity to HIV transmission clusters and permitted scrutiny of factors that favored high cluster connectivity and thus high risk of acquiring HIV [1]. The three factors predicting high connectivity were self-reported bisexual (versus gay) identity, depression, and any marijuana use.
Researchers have long used phylogenetic analysis to delineate sexual networks of people with HIV infection. University of Chicago researchers and colleagues explored using phylogenetic analysis to identify young black MSM with high connectivity to HIV transmission clusters and to pinpoint factors favoring high or low connectivity. Such an analysis, the researchers proposed, can help prioritize HIV prevention interventions for HIV-negative men and thus control HIV outbreaks.
As in other parts of the United States, young black MSM in Chicago run a greater risk of HIV infection than other high-risk groups and help drive continuing spread of the virus. Across the United States, the Chicago team noted, 2 of 3 new HIV diagnoses involve MSM, 1 of 2 involves black MSM, 1 of 4 involves Hispanic MSM, and 1 of 11 involves white MSM. Research on young black MSM identifies three characteristics of their involvement in transmission clusters: (1) They are more likely to be members of HIV transmission clusters [2]. (2) They are more likely to be members of larger transmission clusters. (3) They tend to be members of segregated networks that have higher HIV rates.
The Chicago team planned this analysis (1) to describe local HIV phylogenetic transmission networks and (2) to assess factors associated with HIV phylogenetic transmission cluster size in young black MSM. The analysis focused on young black MSM in uConnect, an ongoing longitudinal study with a survey-based design and blood spot collection. Men are eligible for the study if they identify themselves as African American or black, are born male, are 16 to 29 years old, report oral or anal sex in the past 24 months, and live in Chicago.
The researchers analyzed HIV-1 pol sequences from viral samples of participants and identified transmission between men if their pol sequences were 1.5% or less genetically distant from each other. The research team defined clusters as 1 or more ties to another sequence. They used logistic regression analysis to assess membership in a phylogenetic cluster and Poisson regression to assess numbers of ties to other individuals.
The study group averaged 23.7 years in age (range 16 to 29) and averaged 4.4 sex partners (range 0 to 35). About three quarters of men (76%) identified themselves as homosexual, 55% had condomless sex in the past 12 months, 82% used marijuana, and 28% used any other recreational drug. While 58% of men had health insurance and 58% had some college education, 52% were unemployed, and 53% were ever incarcerated.
Wave 1 of uConnect recruitment included 216 men (35% of the sample) diagnosed with HIV infection. The phylogenetic analysis focused on 54 pol sequences, 53 of them from men with viral suppression. Of the 54 HIV sequences, 42 (78%) had a genetic tie to 1 or more persons. Genetic ties per sequence averaged 4.4 and ranged from 0 to 20. The analysis identified 7 HIV clusters.
Poisson regression analysis singled out four factors independently associated with a high degree of connectivity to HIV clusters among young black MSM, at the following relative risks (RR) and 99.99% confidence intervals (CI):
-- Bisexual versus gay sexual identity: HR 5.55 (99.99% CI 1.56 to 19.81)
-- Depressive symptoms versus none: HR 2.51 (99.99% CI 1.18 to 5.34)
-- Light recreational marijuana use versus never: HR 3.27 (99.99% CI 1.01 to 10.62)
-- Heavy recreational marijuana use versus never: HR 3.10 (99.99% CI 1.05 to 19.23)
Three factors were independently associated with a low degree of connectivity in the clusters:
-- Current insurance: HR 0.22 (99.99% CI 0.11 to 0.44)
-- In a relationship versus single: HR 0.38 (99.99% CI 0.18 to 0.84)
-- Use of one or more recreational drugs besides marijuana versus never: HR 0.21 (99.99% CI 0.05 to 0.91)
The investigators proposed that HIV prevention efforts tailored to these risk factors may help reduce HIV transmission among young black MSM. In particular, they called for greater access to mental health services and youth-focused drug use prevention programs.
References
1. Morgan E, Nyaku A, D'Aquila R, Schneider J. Using phylogenetics of HIV to inform prevention among young black men who have sex with men in Chicago. 21st International AIDS Conference (AIDS 2016). July 18-22, 2016. Durban, South Africa. Abstract THAX0103.
2. Lubelchek RJ, Hoehnen SC, Hotton AL, Kincaid SL, Barker DE, French AL. Transmission clustering among newly diagnosed HIV patients in Chicago, 2008 to 2011: using phylogenetics to expand knowledge of regional HIV transmission patterns. J Acquir Immune Defic Syndr. 2015;68:46-54. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4262705
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