10th Anniversary Conference Of The British HIV Association [BHIVA]


15 – 17 April 2004, City Hall, Cardiff, UK

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[TITLE:] MOLECULAR AND EPIDEMIOLOGICAL CHARACTERISTICS OF PRIMARY HIV-1 INFECTIONS AMONG A COHORT OF PREDOMINANTLY MEN WHO HAVE SEX WITH MEN (MSM) IN A DEFINED GEOGRAPHICAL AREA: TRANSMISSION EVENTS ASSOCIATED WITH HIGH-RISK ACTIVITY AND SEXUALLY TRANSMITTED INFECTIONS (STIS)

[AUTHOR(S):] D Pao1, M Fisher1, G Dean1, T Maher1, S Hué2, P Cane3, C Sabin4, D Pillay2
1 Brighton and Sussex University Hospitals, 2 University College London, 3 University of Birmingham Medical School, 4 Royal Free and University College Medical School, London, UK

BHIVA Conf 2004 Apr 15-17;10:O13

BACKGROUND: It is postulated that onward transmission of HIV-1 is increased during primary HIV infection (PHI) for biological and behavioural reasons. We studied primary infections combining molecular and epidemiological approaches to assess correlates of PHI transmission.

METHODS: PHI was diagnosed between 1999 and 2003 by one or more of: negative HIV antibody (Ab) within 18 months, evolving Ab response or negative detuned Ab. Epidemiological data were collected and pol sequences used to create a phylogenetic tree.

RESULTS: Of the 104 subjects with PHI diagnosed between 1999 and 2003, 96% were men with a median age of 36 years; 91% were MSM. 13% of the pol sequences had primary antiretroviral resistance. Viruses from 38 individuals (36.5%) appeared within 16 transmission clusters. These associations were significant in the cluster versus non-cluster group: unprotected anal intercourse (UPAI) in the 3 months before PHI diagnosis (P=0.03), number of sexual contacts (P=0.02), young age (P=0.02) and CD4 count (P=0.01). Alarmingly high rates of acute STIs were seen (38%).

CONCLUSION: We found high rates of viral clustering in individuals with PHI. The associated behavioural factors we observed can facilitate onward transmission. Increased awareness and targeted identification of individuals during PHI may usefully interrupt transmission networks.

PRESENTING AUTHOR: D Pao

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Copyright © 2004 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD