Undiagnosed HIV Infections May Drive HIV Transmission in the Era of "Treat All": A Deep-Sampling Molecular Network Study in Northeast China during 2016 to 2019

Bin Zhao; Yu Qiu; Wei Song; Mingming Kang; Xue Dong; Xin Li; Lu Wang; Jianmin Liu; Haibo Ding; Zhenxing Chu; Lin Wang; Wen Tian; Hong Shang; Xiaoxu Han

doi:10.3390/v14091895

Undiagnosed HIV Infections May Drive HIV Transmission in the Era of "Treat All": A Deep-Sampling Molecular Network Study in Northeast China during 2016 to 2019

Viruses. 2022 Aug 27;14(9):1895. doi: 10.3390/v14091895.

Authors

Bin Zhao^{1

2

3

4}, Yu Qiu^{1

2

3

4}, Wei Song⁵, Mingming Kang^{1

2

4}, Xue Dong⁵, Xin Li⁵, Lu Wang⁵, Jianmin Liu⁵, Haibo Ding^{1

2

3

4}, Zhenxing Chu^{1

2

3

4}, Lin Wang^{1

2

3

4}, Wen Tian^{1

2

3

4}, Hong Shang^{1

2

3

4}, Xiaoxu Han^{1

2

3

4}

Affiliations

¹ NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, Shenyang 110001, China.
² Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang 110001, China.
³ Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang 110001, China.
⁴ Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou 310003, China.
⁵ Department of Food Safety and Nutrition, Shenyang Center for Health Service and Administrative Law Enforcement (Shenyang Center for Disease Control and Prevention), Shenyang 110031, China.

Abstract

Universal antiretroviral therapy (ART, “treat all”) was recommended by the World Health Organization in 2015; however, HIV-1 transmission is still ongoing. This study characterizes the drivers of HIV transmission in the “treat all” era. Demographic and clinical information and HIV pol gene were collected from all newly diagnosed cases in Shenyang, the largest city in Northeast China, during 2016 to 2019. Molecular networks were constructed based on genetic distance and logistic regression analysis was used to assess potential transmission source characteristics. The cumulative ART coverage in Shenyang increased significantly from 77.0% (485/630) in 2016 to 93.0% (2598/2794) in 2019 (p < 0.001). Molecular networks showed that recent HIV infections linked to untreated individuals decreased from 61.6% in 2017 to 28.9% in 2019, while linking to individuals with viral suppression (VS) increased from 9.0% to 49.0% during the same time frame (p < 0.001). Undiagnosed people living with HIV (PLWH) hidden behind the links between index cases and individuals with VS were likely to be male, younger than 25 years of age, with Manchu nationality (p < 0.05). HIV transmission has declined significantly in the era of “treat all”. Undiagnosed PLWH may drive HIV transmission and should be the target for early detection and intervention.

Keywords: HIV; driving factor; molecular network; treat all.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

China / epidemiology
Female
Genes, pol
HIV Infections* / diagnosis
HIV Infections* / drug therapy
HIV Infections* / epidemiology
HIV-1* / genetics
Humans
Male
Specimen Handling

Grants and funding

This work was supported by Mega-Projects of National Science Research for the 13th Five-Year Plan (2018ZX10721102); The National Natural Science Foundation (81871637); CAMS Innovation Fund for Medical Sciences (2019-I2M-5-027); Scientific Research Funding Project of Liaoning Province Education Department (QN2019005); Shenyang Science and Technology Project (19-112-4-004).