Oliver Stirrup1, Anna Tostevin1, Manon Ragonnet-Cronin2, Erik Volz2, Fiona Burns1,3, Valerie Delpech4, David Dunn1,5. 1. Institute for Global Health, University College London. 2. MRC Centre for Global Infectious Disease Analysis, Jameel Institute for Disease and Emergency Analytics, Imperial College London. 3. Royal Free London NHS Foundation Trust. 4. HIV and STI Department, National Infection Service, Public Health England. 5. MRC Clinical Trials Unit, University College London, London, UK.
Abstract
OBJECTIVES: The aim of this study was to evaluate whether infection occurred pre or postmigration and the associated diagnosis delay in migrants diagnosed with HIV in the UK. DESIGN: We analyzed a cohort of individuals diagnosed with HIV in the UK in 2014-2016 born in Africa or elsewhere in Europe. Inclusion criteria were arrival within 15 years before diagnosis, availability of HIV pol sequence, and viral subtype shared by at least 10 individuals. METHODS: We examined phylogenies for evidence of infection after entry into the UK and incorporated this information into a Bayesian analysis of timing of infection using biomarkers of CD4+ cell count, avidity assays, proportion of ambiguous nucleotides in viral sequences, and last negative test dates where available. RESULTS: One thousand, two hundred and fifty-six individuals were included. The final model indicated that HIV was acquired postmigration for most MSM born in Europe (posterior expectation 65%, 95% credibility interval 64-67%) or Africa (65%, 62-69%), whereas a minority (20-30%) of men and women with heterosexual transmission acquired HIV postmigration. Estimated diagnosis delays were lower for MSM than for those with heterosexual transmission, and were lower for those with postmigration infection across all subgroups. For MSM acquiring HIV postmigration, the estimated mean time to diagnosis was less than one year, but for those who acquired HIV premigration, the mean time from infection to diagnosis was more than five years for all subgroups. CONCLUSION: Acquisition of HIV postmigration is common, particularly among MSM, calling for prevention efforts aimed at migrant communities. Delays in diagnosis reinforce the need for targeted testing initiatives.
OBJECTIVES: The aim of this study was to evaluate whether infection occurred pre or postmigration and the associated diagnosis delay in migrants diagnosed with HIV in the UK. DESIGN: We analyzed a cohort of individuals diagnosed with HIV in the UK in 2014-2016 born in Africa or elsewhere in Europe. Inclusion criteria were arrival within 15 years before diagnosis, availability of HIV pol sequence, and viral subtype shared by at least 10 individuals. METHODS: We examined phylogenies for evidence of infection after entry into the UK and incorporated this information into a Bayesian analysis of timing of infection using biomarkers of CD4+ cell count, avidity assays, proportion of ambiguous nucleotides in viral sequences, and last negative test dates where available. RESULTS: One thousand, two hundred and fifty-six individuals were included. The final model indicated that HIV was acquired postmigration for most MSM born in Europe (posterior expectation 65%, 95% credibility interval 64-67%) or Africa (65%, 62-69%), whereas a minority (20-30%) of men and women with heterosexual transmission acquired HIV postmigration. Estimated diagnosis delays were lower for MSM than for those with heterosexual transmission, and were lower for those with postmigration infection across all subgroups. For MSM acquiring HIV postmigration, the estimated mean time to diagnosis was less than one year, but for those who acquired HIV premigration, the mean time from infection to diagnosis was more than five years for all subgroups. CONCLUSION: Acquisition of HIV postmigration is common, particularly among MSM, calling for prevention efforts aimed at migrant communities. Delays in diagnosis reinforce the need for targeted testing initiatives.
Authors: Nikos Pantazis; Christos Thomadakis; Julia Del Amo; Debora Alvarez-Del Arco; Fiona M Burns; Ibidun Fakoya; Giota Touloumi Journal: Stat Methods Med Res Date: 2017-12-12 Impact factor: 3.021
Authors: Patricia Cane; Ian Chrystie; David Dunn; Barry Evans; Anna Maria Geretti; Hannah Green; Andrew Phillips; Deenan Pillay; Kholoud Porter; Anton Pozniak; Caroline Sabin; Erasmus Smit; Jonathan Weber; Mark Zuckerman Journal: BMJ Date: 2005-11-18
Authors: Ibidun Fakoya; Débora Álvarez-del Arco; Melvina Woode-Owusu; Susana Monge; Yaiza Rivero-Montesdeoca; Valerie Delpech; Brian Rice; Teymur Noori; Anastasia Pharris; Andrew J Amato-Gauci; Julia del Amo; Fiona M Burns Journal: BMC Public Health Date: 2015-06-19 Impact factor: 3.295