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Tracing the Impact of Public Health Interventions on HIV-1 Transmission in Portugal Using Molecular Epidemiology

Título de la revista
Vasylyeva, Tetyana I
du Plessis, Louis
Pineda-Peña, Andrea C
Kühnert, Denise
Lemey, Philippe
Vandamme, Anne-Mieke
Gomes, Perpétua
Camacho, Ricardo J
Pybus, Oliver G
Abecasis, Ana B



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Oxford University Press


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Background: Estimation of temporal changes in human immunodeficiency virus (HIV) transmission patterns can help to elucidate the impact of preventive strategies and public health policies. Methods: Portuguese HIV-1 subtype B and G pol genetic sequences were appended to global reference data sets to identify country-specific transmission clades. Bayesian birth-death models were used to estimate subtype-specific effective reproductive numbers (Re). Discrete trait analysis (DTA) was used to quantify mixing among transmission groups. Results: We identified 5 subtype B Portuguese clades (26-79 sequences) and a large monophyletic subtype G Portuguese clade (236 sequences). We estimated that major shifts in HIV-1 transmission occurred around 1999 (95% Bayesian credible interval [BCI], 1998-2000) and 2000 (95% BCI, 1998-2001) for subtypes B and G, respectively. For subtype B, Re dropped from 1.91 (95% BCI, 1.73-2.09) to 0.62 (95% BCI,.52-.72). For subtype G, Re decreased from 1.49 (95% BCI, 1.39-1.59) to 0.72 (95% BCI,. 63-.8). The DTA suggests that people who inject drugs (PWID) and heterosexuals were the source of most ( and gt;80%) virus lineage transitions for subtypes G and B, respectively. Conclusions: The estimated declines in Re coincide with the introduction of highly active antiretroviral therapy and the scale-up of harm reduction for PWID. Inferred transmission events across transmission groups emphasize the importance of prevention efforts for bridging populations. © 2019 The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.
Palabras clave
Pol protein , Bayes theorem , Genetics , Human , Human immunodeficiency virus 1 , Human immunodeficiency virus infection , Molecular epidemiology , Phylogeny , Portugal , Public health , Virology , Bayes Theorem , HIV Infections , HIV-1 , Humans , Molecular Epidemiology , Phylogeny , Pol Gene Products , Portugal , Public Health , Epidemiology , Harm reduction , HIV , Phylodynamics , Portugal , Reproductive number , Transmission groups