Molecular Epidemiology of the HIV Epidemic in Three German Metropolitan Regions - Cologne/Bonn, Munich and Hannover, 1999-2016

Abstract

Using HIV sequence data to characterize clusters of HIV transmission may provide insight into the epidemic. Phylogenetic and network analyses were performed to infer putative relationships between HIV-1 partial pol sequences from 2,774 individuals receiving care in three German regions between 1999-2016. The regions have in common that they host some of the largest annual festivals in Europe (Carnival and Oktoberfest). Putative links with sequences (n = 150,396) from the Los Alamos HIV Sequence database were evaluated. A total of 595/2,774 (21.4%) sequences linked with at least one other sequence, forming 184 transmission clusters. Clustering individuals were significantly more likely to be younger, male, and report sex with men as their main risk factor (p < 0.001 each). Most clusters (77.2%) consisted exclusively of men; 41 (28.9%) of these included men reporting sex with women. Thirty-two clusters (17.4%) contained sequences from more than one region; clustering men were significantly more likely to be in a position bridging regional HIV epidemics than clustering women (p = 0.027). We found 236 clusters linking 547 sequences from our sample with sequences from the Los Alamos database (n = 1407; 31% from other German centres). These results highlight the pitfalls of focusing HIV prevention efforts on specific risk groups or specific locales.

Trial registration: ClinicalTrials.gov NCT02149004.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1

Maps of (A) Sampled Population, (B) Ratios of Sequences Clustering in each Area. Maps are based on first 3 numbers of zip-codes of residency of reported by participants.

Figure 2

HIV Transmission Network by Center and Region. Individuals (nodes) are shaped as square (men) and circle (women). Nodes are coloured according to the region where they have been identified in yellow (Cologne), red (Bonn), dark green (Munich LMU), light green (TUM Munich) and pink (Hannover). All edges represent a genetic distance ≤1.5% separating nodes.

Figure 3

HIV Transmission Network by Risk Factor and Country of Origin. (A) Nodes are coloured by their reported risk factor in green (men who have sex with men, MSM), orange (heterosexual [HTS]), purple (injection drug use [IDU]) and pink (endemic), respectively. (B) Here, nodes are coloured according to the country/region/continent of origin in green (Germany), orange (Western Europe), purple (Eastern Europe), pink (South-East Asia), yellow (Africa), brown (Middle-East), and red (Central and South America).

Figure 4

Maps showing linkage with publicly available sequences worldwide. (A) Heatmap showing per country number of publicly available sequences linked to this German dataset. (B) Heatmap showing per country number of sequences from this German dataset linked to publicly available sequences worldwide.