The Relationship Between the Human Immunodeficiency Virus-1 Transmission Network and the HIV Care Continuum in Los Angeles County.

Adult Continuity of Patient Care HIV Infections / drug therapy HIV-1 Humans Los Angeles / epidemiology Retrospective Studies
Cox proportional hazard HIV care continuum cluster gamma frailty molecular epidemiology transmission network

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213

Informations de publication

Date de publication:
03 12 2020
Historique:
received: 13 11 2019
accepted: 03 02 2020
pubmed: 6 2 2020
medline: 28 4 2021
entrez: 6 2 2020
Statut: ppublish

Résumé

Public health action combating human immunodeficiency virus (HIV) includes facilitating navigation through the HIV continuum of care: timely diagnosis followed by linkage to care and initiation of antiretroviral therapy to suppress viral replication. Molecular epidemiology can identify rapidly growing HIV genetic transmission clusters. How progression through the care continuum relates to transmission clusters has not been previously characterized. We performed a retrospective study on HIV surveillance data from 5226 adult cases in Los Angeles County diagnosed from 2010 through 2014. Genetic transmission clusters were constructed using HIV-TRACE. Cox proportional hazard models were used to estimate the impact of transmission cluster growth on the time intervals between care continuum events. Gamma frailty models incorporated the effect of heterogeneity associated with genetic transmission clusters. In contrast to our expectations, there were no differences in time to the care continuum events among individuals in clusters with different growth dynamics. However, upon achieving viral suppression, individuals in high growth clusters were slower to experience viral rebound (hazard ratio 0.83, P = .011) compared with individuals in low growth clusters. Heterogeneity associated with cluster membership in the timing to each event in the care continuum was highly significant (P < .001), with and without adjustment for transmission risk and demographics. Individuals within the same transmission cluster have more similar trajectories through the HIV care continuum than those across transmission clusters. These findings suggest molecular epidemiology can assist public health officials in identifying clusters of individuals who may benefit from assistance in navigating the HIV care continuum.

Sections du résumé

BACKGROUND
Public health action combating human immunodeficiency virus (HIV) includes facilitating navigation through the HIV continuum of care: timely diagnosis followed by linkage to care and initiation of antiretroviral therapy to suppress viral replication. Molecular epidemiology can identify rapidly growing HIV genetic transmission clusters. How progression through the care continuum relates to transmission clusters has not been previously characterized.
METHODS
We performed a retrospective study on HIV surveillance data from 5226 adult cases in Los Angeles County diagnosed from 2010 through 2014. Genetic transmission clusters were constructed using HIV-TRACE. Cox proportional hazard models were used to estimate the impact of transmission cluster growth on the time intervals between care continuum events. Gamma frailty models incorporated the effect of heterogeneity associated with genetic transmission clusters.
RESULTS
In contrast to our expectations, there were no differences in time to the care continuum events among individuals in clusters with different growth dynamics. However, upon achieving viral suppression, individuals in high growth clusters were slower to experience viral rebound (hazard ratio 0.83, P = .011) compared with individuals in low growth clusters. Heterogeneity associated with cluster membership in the timing to each event in the care continuum was highly significant (P < .001), with and without adjustment for transmission risk and demographics.
CONCLUSIONS
Individuals within the same transmission cluster have more similar trajectories through the HIV care continuum than those across transmission clusters. These findings suggest molecular epidemiology can assist public health officials in identifying clusters of individuals who may benefit from assistance in navigating the HIV care continuum.

Identifiants

DOI: 10.1093/cid/ciaa114 PMID: 32020172 PMC: PMC7904072
pubmed: 32020172
pii: 5722890
doi: 10.1093/cid/ciaa114
pmc: PMC7904072
doi:

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e384-e391

Subventions

Organisme : NIAID NIH HHS
ID : K01 AI110181
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI036214
Pays : United States
Organisme : NIAID NIH HHS
ID : R01 AI135992
Pays : United States

Informations de copyright

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

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Auteurs

Adiba Hassan (A)

Department of Medicine, University of California, San Diego, California, USA.

Victor De Gruttola (V)

Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Department of Family Medicine, University of California, San Diego, California, USA.

Yunyin W Hu (YW)

Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California, USA.

Zhijuan Sheng (Z)

Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California, USA.

Kathleen Poortinga (K)

Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California, USA.

Joel O Wertheim (JO)

Department of Medicine, University of California, San Diego, California, USA.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › The Relationship Between the Human...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › The Relationship Between the Human...
questionsmedicales.fr › Maladies du système immunitaire › Déficits immunitaires › Infections à VIH › The Relationship Between the Human...
questionsmedicales.fr › Virus › Virus à ARN › Retroviridae › Lentivirus › Lentivirus des primates › VIH (Virus de l'Immunodéficience Humaine) › VIH-1 (Virus de l'Immunodéficience Humaine de type 1) › The Relationship Between the Human...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The Relationship Between the Human...
questionsmedicales.fr › Régions géographiques › Villes › Los Angeles › The Relationship Between the Human...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › The Relationship Between the Human...