Antoine Chaillon1, Santiago Avila-Ríos2, Joel O Wertheim1, Ann Dennis3, Claudia García-Morales2, Daniela Tapia-Trejo2, Carlos Mejía-Villatoro4, Juan M Pascale5, Guillermo Porras-Cortés6, Carlos J Quant-Durán7, Ivette Lorenzana8, Rita I Meza9, Elsa Y Palou10, Marvin Manzanero11, Rolando A Cedillos12, Gustavo Reyes-Terán13, Sanjay R Mehta14. 1. University of California, San Diego, La Jolla, CA, USA. 2. Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico. 3. University of North Carolina, Chapel Hill, NC, USA. 4. Infectious Diseases Clinic, Roosevelt Hospital, Guatemala City, Guatemala. 5. Gorgas Memorial Institute for Health Studies, Panama City, Panama. 6. Vivian Pellas Metropolitan Hospital, Managua, Nicaragua. 7. Roberto Calderón Hospital, Managua, Nicaragua. 8. National Autonomous University of Honduras, Tegucigalpa, Honduras. 9. Honduras National Reference HIV Laboratory, Tegucigalpa, Honduras. 10. University School Hospital, Tegucigalpa, Honduras. 11. Ministry of Health, Belmopan, Belize. 12. Rosales National Hospital, San Salvador, El Salvador. 13. Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico. Electronic address: gustavo.reyesteran@gmail.com. 14. University of California, San Diego, La Jolla, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA. Electronic address: srmehta@ucsd.edu.
Abstract
BACKGROUND: Migration and travel are major drivers of the spread of infectious diseases. Geographic proximity and a common language facilitate travel and migration in Mesoamerica, which in turn could affect the spread of HIV in the region. METHODS: 6092 HIV-1 subtype B partial pol sequences sampled from unique antiretroviral treatment-naïve individuals from Mexico (40.7%), Guatemala (24.4%), Honduras (19%), Panama (8.2%), Nicaragua (5.5%), Belize (1.4%), and El Salvador (0.7%) between 2011 and 2016 were included. Phylogenetic and genetic network analyses were performed to infer putative relationships between HIV sequences. The demographic and geographic associations with clustering were analyzed and viral migration patterns were inferred using the Slatkin-Maddison approach on 100 iterations of random subsets of equal number of sequences per location. RESULTS: A total of 1685/6088 (27.7%) of sequences linked with at least one other sequence, forming 603 putative transmission clusters (range: 2-89 individuals). Clustering individuals were significantly more likely to be younger (median age 29 vs 33years, p<0.01) and men-who-have-sex-with-men (40.4% vs 30.3%, p<0.01). Of the 603 clusters, 30 (5%) included sequences from multiple countries with commonly observed linkages between Mexican and Honduran sequences. Eight of the 603 clusters included >10 individuals, including two comprised exclusively of Guatemalans (52 and 89 individuals). Phylogenetic and migration analyses suggested that the Central and Southern regions of Mexico along with Belize were major sources of HIV throughout the region (p<0.01) with genetic flow southward from Mexico to the other nations of Mesoamerica. We also found evidence of significant viral migration within Mexico. CONCLUSION: International clusters were infrequent, suggesting moderate migration between HIV epidemics of the different Mesoamerican countries. Nevertheless, we observed important sources of transnational HIV spread in the region, including Southern and Central Mexico and Belize.
BACKGROUND: Migration and travel are major drivers of the spread of infectious diseases. Geographic proximity and a common language facilitate travel and migration in Mesoamerica, which in turn could affect the spread of HIV in the region. METHODS: 6092 HIV-1 subtype B partial pol sequences sampled from unique antiretroviral treatment-naïve individuals from Mexico (40.7%), Guatemala (24.4%), Honduras (19%), Panama (8.2%), Nicaragua (5.5%), Belize (1.4%), and El Salvador (0.7%) between 2011 and 2016 were included. Phylogenetic and genetic network analyses were performed to infer putative relationships between HIV sequences. The demographic and geographic associations with clustering were analyzed and viral migration patterns were inferred using the Slatkin-Maddison approach on 100 iterations of random subsets of equal number of sequences per location. RESULTS: A total of 1685/6088 (27.7%) of sequences linked with at least one other sequence, forming 603 putative transmission clusters (range: 2-89 individuals). Clustering individuals were significantly more likely to be younger (median age 29 vs 33years, p<0.01) and men-who-have-sex-with-men (40.4% vs 30.3%, p<0.01). Of the 603 clusters, 30 (5%) included sequences from multiple countries with commonly observed linkages between Mexican and Honduran sequences. Eight of the 603 clusters included >10 individuals, including two comprised exclusively of Guatemalans (52 and 89 individuals). Phylogenetic and migration analyses suggested that the Central and Southern regions of Mexico along with Belize were major sources of HIV throughout the region (p<0.01) with genetic flow southward from Mexico to the other nations of Mesoamerica. We also found evidence of significant viral migration within Mexico. CONCLUSION: International clusters were infrequent, suggesting moderate migration between HIV epidemics of the different Mesoamerican countries. Nevertheless, we observed important sources of transnational HIV spread in the region, including Southern and Central Mexico and Belize.
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