Demographics of sources of HIV-1 transmission in Zambia: a molecular epidemiology analysis in the HPTN 071 PopART study
Matthew Hall, Tanya Golubchik, David Bonsall, Lucie Abeler‐Dörner, Mohammed Limbada, Barry Kosloff, Ab Schaap, Mariateresa de Cesare, George MacIntyre-Cockett, Newton O. Otecko, William J. M. Probert, Oliver Ratmann, Ana Bulas Cruz, Estelle Piwowar‐Manning, David Burns, Myron S. Cohen, Deborah Donnell, Susan H. Eshleman, Musonda Simwinga, Sarah Fidler, Richard Hayes, Helen Ayles, Christophe Fraser, Yaw Agyei, Nulda Beyers, Peter Bock, Virginia Bond, Justin Bwalya, Anne Cori, Anneen van Deventer, Rory Dunbar, Wafaa El‐Sadr, Lynda Emel, Sian Floyd, Sam Griffith, James Hargreaves, Katharina Hauck, Tanette Headen, Graeme Hoddinott, Anelet James, Karen Jennings, Sarah Kanema, Barry Kosloff, James Kruger, Ramya Kumar, David Macleod, Nozizwe Makola, Nomtha Mandla, Eric N. Miller, Ayana Moore, Lawrence Mwenge, Heather Noble, Mwelwa Phiri, Michael Pickles, Kalpana Sabapathy, Ephraim Sakala, Rafael Sauter, Kwame Shanaube, Andrew Silumesi, Nirupama Sista, Tim Skalland, Peter Smith, Ranjeeta Thomas, Sten H. Vermund, Rhonda White, Ethan Wilson, Blia Yang, Krista Yuhas, Rory Bowden, Vincent Cálvez, Max Essex, Kate Grabowski, Ravindra K. Gupta, Joshua T. Herbeck, Joseph Kagaayi, Pontiano Kaleebu, Jairam R. Lingappa, Sikhulile Moyo, Vladimir Novitsky, Thumbi Ndung’u, Deenan Pillay, Thomas C. Quinn, Andrew Rambaut, Janet Seeley, Deogratius Ssemwanga, Frank Tanser, Maria J. Wawer
Abstract
BACKGROUND: In the last decade, universally available antiretroviral therapy (ART) has led to greatly improved health and survival of people living with HIV in sub-Saharan Africa, but new infections continue to appear. The design of effective prevention strategies requires the demographic characterisation of individuals acting as sources of infection, which is the aim of this study. METHODS: Between 2014 and 2018, the HPTN 071 PopART study was conducted to quantify the public health benefits of ART. Viral samples from 7124 study participants in Zambia were deep-sequenced as part of HPTN 071-02 PopART Phylogenetics, an ancillary study. We used these sequences to identify likely transmission pairs. After demographic weighting of the recipients in these pairs to match the overall HIV-positive population, we analysed the demographic characteristics of the sources to better understand transmission in the general population. FINDINGS: We identified a total of 300 likely transmission pairs. 178 (59·4%) were male to female, with 130 (95% CI 110-150; 43·3%) from males aged 25-40 years. Overall, men transmitted 2·09-fold (2·06-2·29) more infections per capita than women, a ratio peaking at 5·87 (2·78-15·8) in the 35-39 years source age group. 40 (26-57; 13·2%) transmissions linked individuals from different communities in the trial. Of 288 sources with recorded information on drug resistance mutations, 52 (38-69; 18·1%) carried viruses resistant to first-line ART. INTERPRETATION: HIV-1 transmission in the HPTN 071 study communities comes from a wide range of age and sex groups, and there is no outsized contribution to new infections from importation or drug resistance mutations. Men aged 25-39 years, underserved by current treatment and prevention services, should be prioritised for HIV testing and ART. FUNDING: National Institute of Allergy and Infectious Diseases, US President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, Bill & Melinda Gates Foundation, National Institute on Drug Abuse, and National Institute of Mental Health.