Study On The Association Between Homosexual Transmission And Female Heterosexual Transmission Of HIV-1 In Guangzhou

ObjectiveBased on the database of HIV-1 infections in Guangzhou from 2008 to 2017,HIV-1 molecular network was constructed to comprehensively analyze the association between female heterosexual transmission and homosexual transmission,to provide information and direction for controlling the female HIV epidemic and preventing further transmission and spread of HIV-1 in the female groups.MethodsSerum samples of newly diagnosed HIV-1 positive subjects claimed to be infected through homosexual transmission(MSM),heterosexual transmission(HET),and injecting drug use transmission(IDU)in Guangzhou from 2008 to 2017 were collected.After HIV RNA extraction,pol region gene amplification and sequencing,the sequences were collated,spliced,compared and subtype identified.A genetic distance of 1.5% was selected to construct a molecular network by HIV-TRACE.Cytoscape was used to understand the potential linkage and measure centrality metric.Bayesian phylogenetic analysis was used to infer the origin and transmission path of heterosexual women linked to MSM in Guangzhou.Results1.Characteristics of subjects: 4292 HIV-1 sequences were obtained,including 3860 men and 432 women.Among the subjects,MSM was the main risk groups,accounting for 50.7%,and HET and IDU accounted for35.6% and 13.7%,respectively.2.Factors correlated with clustering: In total,66.9% of the sequences were linked to at least one other sequence,and 2710 male(70.2%)and 162female(37.5%)sequences were clustered to form 259 molecular clusters.Younger,MSM and heterosexual men,CRF55＿01B,CRF07＿BC and CRF01＿AE,confirmed infection in 2008-2011 were more likely to cluster.3.Characteristics of super-spreaders: The degree of nodes ranges from 1 to 771.Among them,722 nodes are in the highest quartile,which were defined as super-spreaders.Male,21-50 years old,higher education,employment,foreign domicile,CRF55＿01B and CRF07＿BC,early confirmed HIV-1 infected has a higher proportion of being super-spreaders.4.Potential transmission linkages: Of MSM in the molecular network,80.5% were linked to MSM,and few were found to be linked to heterosexual men(16.4%)and heterosexual women(0.9%).Heterosexual men commonly linked to MSM(56.9%)than to other heterosexual men(25.6%)or heterosexual women(8.8%).Of heterosexual women,45.4%were linked to heterosexual men and 17.7% to MSM.5.Molecular clusters patterns: 151 dyads(58.3%,2 sequences)and108 networks(41.7%,≥3 sequences)were identified.The clusters mixed with MSM and HET were easier to form larger molecular networks.6.Characteristic of MSM networks and HET networks: most of the male infections were in the MSM networks(90.5%),while the female infections were mainly in the HET networks(41.2%)and MSM networks(40.0%).Heterosexual women with subtypes of CRF55＿01B and CRF07＿BC were more likely to enter the MSM networks.Among women with confirmed infection from 2008-2017,the probability of entering MSM networks increased.7.Characteristic of linkage between MSM and heterosexual women:There were 628 MSM linked to heterosexual women and 33 heterosexual women linked to MSM.HIV-1 subtypes were CRF01＿AE,CRF07＿BC,CRF55＿01B and CRF59＿01B.Among MSM,the percentage linked to heterosexual women was higher for older,married,less-educated,employed,provincial,infected with CRF55＿01B and CRF07＿BC and super-spreaders.A higher proportion of heterosexual women with subtypes of CRF55＿01B and CRF07＿BC,super-spreaders,and confirmed infection in 2012-2017 were linked to MSM.8.Position of heterosexual women linked to MSM: Heterosexual women linked to MSM could be in peripheral positions of the molecular networks,but played an important role in HIV-1 transmission than normal heterosexual women.9.Transmission origin: Overall,36.4% of heterosexual women linked to MSM diverged from the MSM evolutionary branch,that is,the origin of infection was MSM.63.6% diverged from the HET evolutionary branch,that is,the origin of infection was HET.ConclusionsIn summary,HIV-1 infections claimed to be infected through HET,MSM and IDU in Guangzhou from 2008 to 2017 formed a complex transmission network,and heterosexuals and MSM were more likely to spread HIV-1.The main sources of HIV-1 infection in Guangzhou heterosexual women were heterosexual men and IDUs,but the transmission role of MSM cannot be ignored.There was a high proportion of heterosexual women linked to MSM in Guangzhou could be in peripheral positions of the molecular networks.Effective intervention against MSM can control the epidemic of HIV-1 in heterosexual women.