TY - JOUR
T1 - Recent and rapid transmission of HIV among people who inject drugs in Scotland revealed through phylogenetic analysis
AU - Ragonnet-Cronin, Manon
AU - Jackson, Celia
AU - Bradley-Stewart, Amanda
AU - Aitken, Celia
AU - McAuley, Andrew
AU - Palmateer, Norah
AU - Gunson, Rory
AU - Goldberg, David
AU - Milosevic, Catriona
AU - Leigh-Brown, Andrew J.
N1 - Acceptance from webpage
AAM: 12m embargo
File deposited after deadline - contacted Edinburgh repository for dates. ET 30/10/19
Edinburgh confirmed not compliant also re deposit via email on 5/11/19. ET
Exception email to author. ET 6/11/19
^Author exception email in SAN. ET 13/11/19
PY - 2018/6/15
Y1 - 2018/6/15
N2 - 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.
AB - 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.
KW - HIV
KW - phylodynamic
KW - people who inject drugs
KW - network
KW - transmission
U2 - 10.1093/infdis/jiy130
DO - 10.1093/infdis/jiy130
M3 - Article
C2 - 29546333
VL - 217
SP - 1875
EP - 1882
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
SN - 0022-1899
IS - 12
ER -