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1 April 2007

Volume 195, Number 7
The Journal of Infectious Diseases 2007;195:951–959
© 2007 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2007/19507-0007$15.00
DOI: 10.1086/512088
MAJOR ARTICLE

High Rates of Forward Transmission Events after Acute/Early HIV‐1 Infection

Bluma G. Brenner,1

Michel Roger,2

Jean‐Pierre Routy,3

Daniela Moisi,1

Michel Ntemgwa,1

Claudine Matte,2

Jean‐Guy Baril,4

Réjean Thomas,5

Danielle Rouleau,2

Julie Bruneau,6

Roger Leblanc,7

Mario Legault,8

Cecile Tremblay,9

Hugues Charest,10

Mark A. Wainberg,1 and the

Quebec Primary HIV Infection Study Groupa

1McGill AIDS Centre–Jewish General Hospital, 2Centre Hospitalier de Université de Montréal (CHUM)–Hôpital Notre‐Dame, 3McGill University Health Centre, 4Clinique Médicale du Quartier Latin, 5Clinique Médicale l’Actuel, 6CHUM–Hôpital St. Luc, 7Clinique Médicale Goldberg, LeBlanc, & Rosengren, 8Fonds de la Recherche en Santé du Québec–SIDA Network, 9CHUM–Hôtel Dieu, and 10Institut National de Santé Publique du Québec, Montreal, Canada

Background.A population‐based phylogenetic approach was used to characterize human immunodeficiency virus (HIV)–transmission dynamics in Quebec.

Methods.HIV‐1 pol sequences included primary HIV infections (PHIs; <6 months after seroconversion) from the Quebec PHI cohort (1998–2005; ) and the provincial genotyping program (2001–2005; ). Phylogenetic analysis determined sequence interrelationships among unique PHIs ( ) and infections from untreated ( ) and treated ( ) chronically infected (CI) potential transmitter populations (2001–2005). Clinical features, risk factors, and drug resistance for clustered and nonclustered transmission events were ascertained.

Results.Viruses from 49.4% (293/593) of PHIs cosegregated into 75 transmission chains with 2–17 transmissions/cluster. Half of the clusters included ( ) transmissions, whereas the remainder had transmissions. Maximum periods for onward transmission in clusters were months. Coclustering of untreated and treated CIs with PHIs were infrequent (6.2% and 4.8%, respectively). The ages, viremia, and risk factors were similar for clustered and nonclustered transmission events. Low prevalence of drug resistance in PHI supported amplified transmissions at early stages.

Conclusions.Early infection accounts for approximately half of onward transmissions in this urban North American study. Therapy at early stages of disease may prevent onward HIV transmission.

Received 6 September 2006; accepted 3 October 2006; electronically published 16 February 2007.

Reprints or correspondence: Dr. Mark Wainberg, McGill AIDS Centre, 3755 Cote Ste. Catherine Rd., Montreal, Quebec, Canada H3W 1G4 ().

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  • Potential conflicts of interest: none reported.

    Presented in part: XIV International HIV Drug Resistance Workshop, Quebec City, Canada, 7–11 June 2005 (abstract 112).

    Financial support: Canadian Institutes for Health Research (grant MT‐14738 for resistance genotyping in the Quebec Primary HIV Infection [PHI] cohort study and for research on PHI); Réseau SIDA of the Fonds de la Recherche en Santé du Québec (funds to recruit patients into the Quebec PHI cohort study); Quebec Ministry of Health (funds to the provincial genotypic resistance testing program).

  • Study group members are listed after the text.

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