Transmission network and phylogenetic analysis reveal older male-centered transmission of CRF01_AE and CRF07_BC in Guangxi, China

ABSTRACT

In China, the number of newly reported HIV infections in older people is increasing rapidly. However, clear information on the impact of older people on HIV transmission is limited. This study aims to reveal the local HIV transmission patterns, especially how older people affect virus transmission. Subtype analysis based on available pol sequences obtained from HIV patients revealed that CRF01_AE and CRF08_BC were predominant in patients aged <50 years, whereas CRF01_AE was predominant in older people aged ≥50 years (χ²= 29.299, P < 0.001). A total of 25 patients (5.2%, 25/484) were identified with recent HIV infection (RHI). Transmission network analysis found 267 genetically linked individuals forming 55 clusters (2–63 individuals), including 5 large transmission clusters and 12 transmission clusters containing RHI. Bayesian phylogenetic analysis suggested that transmission events in CRF01_AE and CRF07_BC were centred on older males, while transmission events in CRF08_BC were centred on younger males. Multivariable logistic regression analysis showed that older people were more likely to cluster within networks (AOR = 2.303, 95% CI: 1.012–5.241) and that RHI was a significant factor associated with high linkage (AOR = 3.468, 95% CI: 1.315–9.146). This study provides molecular evidence that older males play a central role in the local transmission of CRF01_AE and CRF07_BC in Guangxi. Given the current widespread of CRF01_AE and CRF07_BC in Guangxi, there is a need to recommend HIV screening as part of free national medical examinations for older people to improve early detection, timely treatment, and further reduce second-generation transmission.

KEYWORDS:

• HIV/AIDS
• older people
• transmission networks
• phylogenetic
• molecular epidemiology

Acknowledgements

We thank all the volunteer patients who participated in this study. We thank all researchers involved in this study and the staff of the Qinzhou Center for Disease Control and Prevention and the Lingshan County Center for Disease Control and Prevention for their support.

Author contributions

Bingyu Liang, Hao Liang and Li Ye conceived and designed the study. Fei Zhang and Yao Yang analyzed the data and wrote the manuscript. Na Liang performed the experiments and clean up the sequence data. Huayue Liang assisted in the Bayesian phylogenetic analysis. Zhaosen Lin, Tongbi Chen, Rongye Chen, and Yongzheng Chen assisted with the epidemiological survey and the sample collection. Wenling Tan, Fuling Chen, Lin Yao and Xingzhen Huang separated the plasma samples. Yuan Yang directed the PCR experiments.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Natural Science and Technology Foundation of China [grant number 82060610 and 82103899], Guangxi Scientific and Technological Key Project [Guike AB19245038 and Guike AB18050022].