Recent and rapid transmission of HIV among people who inject drugs in Scotland revealed through phylogenetic analysis

Manon Ragonnet-Cronin*, Celia Jackson, Amanda Bradley-Stewart, Celia Aitken, Andrew McAuley, Norah Palmateer, Rory Gunson, David Goldberg, Catriona Milosevic, Andrew J. Leigh-Brown

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

36 Citations (Scopus)
95 Downloads (Pure)


Background: Harm reduction has dramatically reduced HIV incidence among people who inject drugs (PWID). In Glasgow, Scotland, <10 infections/year have been diagnosed among PWID since the mid-1990s. However, in 2015 a sharp rise in diagnoses was noted among PWID; many were subtype C with 2 identical drug-resistant mutations and some displayed low avidity, suggesting the infections were linked and recent.

Methods: We collected Scottish pol sequences and identified closely related sequences from public databases. Genetic linkage was ascertained among 228 Scottish, 1820 UK, and 524 global sequences. The outbreak cluster was extracted to estimate epidemic parameters.

Results: All 104 outbreak sequences originated from Scotland and contained E138A and V179E. Mean genetic distance was <1% and mean time between transmissions was 6.7 months. The average number of onward transmissions consistently exceeded 1, indicating that spread was ongoing.

Conclusions: In contrast to other recent HIV outbreaks among PWID, harm reduction services were not clearly reduced in Scotland. Nonetheless, the high proportion of individuals with a history of homelessness (45%) suggests that services were inadequate for those in precarious living situations. The high prevalence of hepatitis C (>90%) is indicative of sharing of injecting equipment. Monitoring the epidemic phylogenetically in real time may accelerate public health action.

Original languageEnglish
Pages (from-to)1875-1882
Number of pages8
JournalJournal of Infectious Diseases
Issue number12
Early online date10 Apr 2018
Publication statusPublished - 15 Jun 2018


  • HIV
  • phylodynamic
  • people who inject drugs
  • network
  • transmission


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