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HIV-1 transmission between MSM and heterosexuals, and increasing proportions of circulating recombinant forms in the Nordic Countries

Journal article
Authors J. Esbjornsson
M. Mild
A. Audelin
J. Fonager
H. Skar
L. B. Jorgensen
K. Liitsola
P. Bjorkman
G. Bratt
Magnus Gisslén
A. Sonnerborg
C. Nielsen
P. Medstrand
J. Albert
Published in Virus Evolution
Volume 2
Issue 1
ISSN 2057-1577
Publication year 2016
Published at Institute of Biomedicine, Department of Infectious Medicine
Language en
Keywords HIV-1, subtype, transmission, molecular epidemiology, phylogeny, replicative fitness, drug-users, subtype-a, epidemic, men, crf02-ag, sex, determinants, netherlands, resistance, Virology
Subject categories Clinical virology


Increased knowledge about HIV-1 transmission dynamics in different transmission groups and geographical regions is fundamental for assessing and designing prevention efforts against HIV-1 spread. Since the first reported cases of HIV infection during the early 1980s, the HIV-1 epidemic in the Nordic countries has been dominated by HIV-1 subtype B and MSM transmission. HIV-1 pol sequences and clinical data of 51 per cent of all newly diagnosed HIV-1 infections in Sweden, Denmark, and Finland in the period 2000-2012 (N = 3,802) were analysed together with a large reference sequence dataset (N = 4,537) by trend analysis and phylogenetics. Analysis of the eight dominating subtypes and CRFs in the Nordic countries (A, B, C, D, G, CRF01_AE, CRF02_AG, and CRF06_cpx) showed that the subtype B proportion decreased while the CRF proportion increased over the study period. A majority (57 per cent) of the Nordic sequences formed transmission clusters, with evidence of mixing both geographically and between transmission groups. Detailed analyses showed multiple occasions of transmissions from MSM to heterosexuals and that active transmission clusters more often involved single than multiple Nordic countries. The strongest geographical link was between Denmark and Sweden. Finally, Denmark had a larger proportion of heterosexual domestic spread of HIV-1 subtype B (75 per cent) compared with Sweden (49 per cent) and Finland (57 per cent). We describe different HIV-1 transmission patterns between countries and transmission groups in a large geographical region. Our results may have implications for public health interventions in targeting HIV-1 transmission networks and identifying where to introduce such interventions.

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