Molecular Epidemiology of HIV-1 among Prisoners in Central Brazil and Evidence of Transmission Clusters

Abstract

Higher rates of human immunodeficiency virus (HIV) infection have been detected in prisoners when compared with the general population, but research into HIV molecular epidemiology and its transmission network has been lacking among them. Thus, this study aimed to verify potential HIV molecular transmission networks among prisoners. In addition, we aimed to describe the mutations related to antiretroviral resistance in these isolates. Thus, we conducted a cross-sectional survey from 2013 to 2018 in prisons in Central-Western Brazil, and the final sampling composed of 84 prisoners. Proviral DNA was extracted from each whole blood sample followed by amplification of the partial polymerase gene and sequencing. Forty-nine sequences (58.3%) were classified as subtype B, followed by C (14.3%), D, and F1 (2.4% each). A complex and dynamic HIV-1 epidemic is observed in the prisons, as 25% of the sequences were recombinant forms. We detected 15 HIV transmission clusters composed of at least two sequences, that included not only prisoners but also individuals from the general population from the same State with a variety of risk behaviors. Thirty-two percent (32.0%) of treatment-experienced prisoners had at least one drug resistance mutation (DRM), while transmitted DRMs were found in 5.9% of the prisoners. We highlight the urgent need for routine surveillance of HIV-1 infection including resistance genotypic tests considering the high disease burden, risky behaviors inside prisons, and the dynamic relationship of prisoners with the outside community.

Keywords: HIV; drug resistance mutations; molecular epidemiology; transmission network; vulnerable population.

Figure 1

Flowchart of obtaining HIV-1 sequences from infected prisoners in this study [6,24].

Figure 2

Neighbor-Joining (NJ) phylogenetic tree of 84 HIV-1 PR/RT sequences from prisoners from Mato Grosso do Sul, Central-West Brazil. The analyzed PR/RT alignment covered a fragment of 1261 bp, corresponding to nucleotides 2254 to 3514 relative to HXB2 genome. Sequences from this study are marked with a full circle. Bootstrap values are represented only if >80. (A) Pure HIV-1 subtypes, involving 120 HIV-1 PR/RT sequences and (B) Recombinant sequences, involving 96 HIV-1 PR/RT sequences.