Christian A W Bruhn1, Anne M Audelin, Marie Helleberg, Karen Bjorn-Mortensen, Niels Obel, Jan Gerstoft, Claus Nielsen, Mads Melbye, Patrik Medstrand, M Thomas P Gilbert, Joakim Esbjörnsson. 1. aCentre for GeoGenetics and Section for Evolutionary Genomics, Natural History Museum of Denmark, University of Copenhagen, Copenhagen, Denmark bDepartment of Laboratory Medicine Malmö, Lund University, Malmö, Sweden cMicrobiological Diagnostics and Virology, Statens Serum Institut, Copenhagen dDepartment of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet eFaculty of Health and Medical Sciences, University of Copenhagen fDepartment of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark gNuffield Department of Medicine, NDM Research Building, University of Oxford, Oxford, UK hDepartment of Microbiology, Tumor and Cell biology (MTC), Karolinska Institute, Stockholm, Sweden iREGA Institute, Katholieke Universiteit, Leuven, Belgium.
Abstract
OBJECTIVES: To describe, at patient-level detail, the determining events and factors involved in the development of a country's HIV-1 epidemic. DESIGN: Clinical information for all recorded Greenlandic HIV-1 patients was analysed and correlated with both novel and previously analysed pol sequences, representing more than half of the entire Greenlandic HIV-1 epidemic. Archival blood samples were sequenced to link early infection chain descriptions to the subsequent epidemic. METHODS: In-depth phylogenetic analyses were used in synergy with clinical information to assess number of introductions of HIV-1 into Greenland, the source of geographic origin, time of epidemic introduction and its epidemiological characteristics such as initial transmission chain, geographic dispersal within Greenland, method of infection, cluster size, sociological and behavioural factors. RESULTS: Despite its small population size and isolated geographic location, data support at least 25 introductions of HIV-1 into Greenland. Only a single of these led to an epidemic. This introduction occurred between 1985 and 1986, and the epidemic cluster is still active. Facilitating factors for the emergence and spread of the epidemic cluster include a rapid transition from MSM to heterosexual spread, high prevalence of other sexually transmitted diseases, rapid dispersal to larger cities and early emergence in a distinct subpopulation with high-risk behaviour including disregard for condomizing. CONCLUSIONS: The synergistic use of disparate data categories yields such unique detail, that the Greenland epidemic now serves as a model example for the epidemic emergence of HIV-1 in a society. This renders it suitable for testing of present and future sequence-based epidemiological methodologies.
OBJECTIVES: To describe, at patient-level detail, the determining events and factors involved in the development of a country's HIV-1 epidemic. DESIGN: Clinical information for all recorded Greenlandic HIV-1patients was analysed and correlated with both novel and previously analysed pol sequences, representing more than half of the entire Greenlandic HIV-1 epidemic. Archival blood samples were sequenced to link early infection chain descriptions to the subsequent epidemic. METHODS: In-depth phylogenetic analyses were used in synergy with clinical information to assess number of introductions of HIV-1 into Greenland, the source of geographic origin, time of epidemic introduction and its epidemiological characteristics such as initial transmission chain, geographic dispersal within Greenland, method of infection, cluster size, sociological and behavioural factors. RESULTS: Despite its small population size and isolated geographic location, data support at least 25 introductions of HIV-1 into Greenland. Only a single of these led to an epidemic. This introduction occurred between 1985 and 1986, and the epidemic cluster is still active. Facilitating factors for the emergence and spread of the epidemic cluster include a rapid transition from MSM to heterosexual spread, high prevalence of other sexually transmitted diseases, rapid dispersal to larger cities and early emergence in a distinct subpopulation with high-risk behaviour including disregard for condomizing. CONCLUSIONS: The synergistic use of disparate data categories yields such unique detail, that the Greenland epidemic now serves as a model example for the epidemic emergence of HIV-1 in a society. This renders it suitable for testing of present and future sequence-based epidemiological methodologies.
Authors: Joakim Esbjörnsson; Mattias Mild; Anne Audelin; Jannik Fonager; Helena Skar; Louise Bruun Jørgensen; Kirsi Liitsola; Per Björkman; Göran Bratt; Magnus Gisslén; Anders Sönnerborg; Claus Nielsen; Patrik Medstrand; Jan Albert Journal: Virus Evol Date: 2016-04-27
Authors: Joakim Esbjörnsson; Eduard J Sanders; George M Nduva; Amin S Hassan; Jamirah Nazziwa; Susan M Graham Journal: Sci Rep Date: 2020-04-21 Impact factor: 4.379
Authors: George M Nduva; Frederick Otieno; Joshua Kimani; Lyle R McKinnon; Francois Cholette; Paul Sandstrom; Susan M Graham; Matt A Price; Adrian D Smith; Robert C Bailey; Amin S Hassan; Joakim Esbjörnsson; Eduard J Sanders Journal: Front Microbiol Date: 2022-03-09 Impact factor: 5.640