Molecular epidemiology of HIV among people who inject drugs after the HIV-outbreak in Athens, Greece: Evidence for a 'slow burn' outbreak

Evangelia Georgia Kostaki; Sotirios Roussos; Anastasia Maria Kefala; Stefanos Limnaios; Mina Psichogiou; Eleni Papachristou; Georgios Nikolopoulos; Eleni Flountzi; Samuel R Friedman; Pagona Lagiou; Angelos Hatzakis; Vana Sypsa; Gkikas Magiorkinis; Apostolos Beloukas; Dimitrios Paraskevis

doi:10.1016/j.meegid.2024.105597

Molecular epidemiology of HIV among people who inject drugs after the HIV-outbreak in Athens, Greece: Evidence for a 'slow burn' outbreak

Infect Genet Evol. 2024 Apr 23:121:105597. doi: 10.1016/j.meegid.2024.105597. Online ahead of print.

Authors

Affiliations

¹ Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
² Department of Biomedical Sciences, University of West Attica, Athens, Greece.
³ First Department of Internal Medicine, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
⁴ Medical School, University of Cyprus, Nicosia, Cyprus.
⁵ Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, New York City, USA.
⁶ Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: gmagi@med.uoa.gr.
⁷ Department of Biomedical Sciences, University of West Attica, Athens, Greece; National AIDS Reference Centre of Southern Greece, Department of Public Health Policy, University of West Attica, Athens, Greece. Electronic address: abeloukas@uniwa.gr.
⁸ Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: dparask@med.uoa.gr.

PMID: 38663466
DOI: 10.1016/j.meegid.2024.105597

Abstract

Background: New diagnoses of HIV-1 infection among people who inject drugs (PWID) in Athens, Greece, saw a significant increase in 2011 and a subsequent decline after 2013. Despite this, ongoing HIV-1 transmission persisted from 2014 to 2020 within this population. Our objective was to estimate the time of infection for PWID in Athens following the HIV-1 outbreak, explore the patterns of HIV-1 dispersal over time, and determine the duration from infection to diagnosis.

Methods: Time from HIV-1 infection to diagnosis was estimated for 844 individuals infected within 4 PWID-specific clusters and for 8 PWID infected with sub-subtype A6 diagnosed during 2010-2019. Phylogeny reconstruction was performed using the maximum-likelihood method. HIV-1 infection dates were based on molecular clock calculations.

Results: In total 86 of 92 (93.5%) sequences from PWID diagnosed during 2016-2019 were either related to the previously identified PWID-specific clusters (n = 81) or belonged to a new A6 cluster (n = 5). The median time between infection and diagnosis was 0.42 years during the outbreak period and 0.70 years during 2016-2019 (p < 0.001). The proportion of clustered sequences from PWID was very low at 5.3% during the pre-outbreak period (1998-2009), saw an increase to 41.7% one year before the outbreak in 2010, and consistently remained high during the whole period after 2011, spanning the post-outbreak period (2016-2019) with a range from 92.9% to 100%.

Conclusions: The substantial proportion of clustered infections (93.5%) during 2016-2019 implies a persistent 'slow burn' HIV outbreak among PWID in Athens, suggesting that the outbreak was not successfully eliminated. The consistently high proportion of clustered sequences since the onset of the outbreak suggests the persistence of ongoing HIV-1 transmission attributed to injection practices. Our findings underscore the importance of targeted interventions among PWID, considering the ongoing transmission rate and prolonged time from infection to diagnosis.

Keywords: Greece; HIV-1; Molecular epidemiology; Outbreak; PWID; Phylodynamic analysis; Transmission clusters.