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. 2023 Dec 13;15(12):2418.
doi: 10.3390/v15122418.

The Role of Late Presenters in HIV-1 Transmission Clusters in Europe

Mafalda N S Miranda  1 , Victor Pimentel  1 , Perpétua Gomes  2   3 , Maria do Rosário O Martins  1 , Sofia G Seabra  1 , Rolf Kaiser  4   5 , Michael Böhm  4   5 , Carole Seguin-Devaux  6 , Roger Paredes  7 , Marina Bobkova  8 , Maurizio Zazzi  9 , Francesca Incardona  10   11 , Marta Pingarilho  1 , Ana B Abecasis  1
Affiliations

The Role of Late Presenters in HIV-1 Transmission Clusters in Europe

Mafalda N S Miranda et al. Viruses. .

Abstract

Background: Investigating the role of late presenters (LPs) in HIV-1 transmission is important, as they can contribute to the onward spread of HIV-1 virus before diagnosis, when they are not aware of their HIV status.

Objective: To characterize individuals living with HIV-1 followed up in Europe infected with subtypes A, B, and G and to compare transmission clusters (TC) in LP vs. non-late presenter (NLP) populations.

Methods: Information from a convenience sample of 2679 individuals living with HIV-1 was collected from the EuResist Integrated Database between 2008 and 2019. Maximum likelihood (ML) phylogenies were constructed using FastTree. Transmission clusters were identified using Cluster Picker. Statistical analyses were performed using R.

Results: 2437 (91.0%) sequences were from subtype B, 168 (6.3%) from subtype A, and 74 (2.8%) from subtype G. The median age was 39 y/o (IQR: 31.0-47.0) and 85.2% of individuals were males. The main transmission route was via homosexual (MSM) contact (60.1%) and 85.0% originated from Western Europe. In total, 54.7% of individuals were classified as LPs and 41.7% of individuals were inside TCs. In subtype A, individuals in TCs were more frequently males and natives with a recent infection. For subtype B, individuals in TCs were more frequently individuals with MSM transmission route and with a recent infection. For subtype G, individuals in TCs were those with a recent infection. When analyzing cluster size, we found that LPs more frequently belonged to small clusters (<8 individuals), particularly dual clusters (2 individuals).

Conclusion: LP individuals are more present either outside or in small clusters, indicating a limited role of late presentation to HIV-1 transmission.

Keywords: HIV-1 infection; late presenters; non-late presenters; transmission clusters.

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Conflict of interest statement

The author Francesca Incardona is employed by InformaPRO S.r.l. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Phylogenetic tree for subtype A. This image shows a visual phylogenetic tree of the subtype A population. (a,b) are zoom images of the shadow zones A and B, respectively. Shadows A and B show the two portions/monophyletic clusters of the phylogenetic tree where the large majority of patients in our population clustered. Shadow A shows one major cluster of individuals originating from Africa and Eastern Europe with heterosexual and IDU transmission. Shadow B shows a cluster of individuals originating from Western Europe and with MSM transmission. C—clusters; RO—region of origin; T—transmission; LP—late presenters vs. non-late presenters; MS—migration status.
Figure 2
Figure 2
Phylogenetic tree for Subtype B. Visualization of the phylogenetic tree of subtype B. The region highlighted with an arrow indicates a monophyletic cluster of individuals with IDU transmission and originating from Western Europe. C—clusters; RO—region of origin; T—transmission; LP—late presenters vs. non-late presenters; MS—migration status.
Figure 3
Figure 3
Phylogenetic tree for subtype G. This image shows a visual phylogenetic tree of the subtype G population. The regions highlighted with arrows shows monophyletic clusters dominated by individuals originating from Western Europe (A) and Africa (B). C—clusters; RO—region of origin; T—transmission; LP—late presenters vs. non-late presenters; MS—migration status.
Figure 4
Figure 4
Characterization of cluster size according to late presentation (A) and cluster size according to subtype of infection (B). A cluster size <8 includes dual clusters (2 patients).
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