The origin and emergence of an HIV-1 epidemic:: from introduction to endemicity

Christian Anders Wathne Bruhn; Anne M. Audelin; Marie Helleberg; Karen Bjorn-Mortensen; Niels Obel; Jan Gerstoft; Claus Nielsen; Mads Melbye; Patrik Medstrand; M. Thomas P. Gilbert; Joakim Esbjörnsson

doi:10.1097/QAD.0000000000000198

The origin and emergence of an HIV-1 epidemic: from introduction to endemicity

Christian Anders Wathne Bruhn, Anne M. Audelin, Marie Helleberg, Karen Bjorn-Mortensen, Niels Obel, Jan Gerstoft, Claus Nielsen, Mads Melbye, Patrik Medstrand, M. Thomas P. Gilbert, Joakim Esbjörnsson

Department of Clinical Medicine

10 Citations (Scopus)

Abstract

Objectives: To describe, at patient-level detail, the determining events and factors involved in the development of a country's HIV-1 epidemic. Design: Clinical information for all recorded Greenlandic HIV-1 patients was analysed and correlated with both novel and previously analysed pol sequences, representing more than half of the entire Greenlandic HIV-1 epidemic. Archival blood samples were sequenced to link early infection chain descriptions to the subsequent epidemic. Methods: In-depth phylogenetic analyses were used in synergy with clinical information to assess number of introductions of HIV-1 into Greenland, the source of geographic origin, time of epidemic introduction and its epidemiological characteristics such as initial transmission chain, geographic dispersal within Greenland, method of infection, cluster size, sociological and behavioural factors. Results: Despite its small population size and isolated geographic location, data support at least 25 introductions of HIV-1 into Greenland. Only a single of these led to an epidemic. This introduction occurred between 1985 and 1986, and the epidemic cluster is still active. Facilitating factors for the emergence and spread of the epidemic cluster include a rapid transition from MSM to heterosexual spread, high prevalence of other sexually transmitted diseases, rapid dispersal to larger cities and early emergence in a distinct subpopulation with high-risk behaviour including disregard for condomizing. Conclusions: The synergistic use of disparate data categories yields such unique detail, that the Greenland epidemic now serves as a model example for the epidemic emergence of HIV-1 in a society. This renders it suitable for testing of present and future sequence-based epidemiological methodologies.

Original language	English
Journal	AIDS (London, England)
Volume	28
Issue number	7
Pages (from-to)	1031-1040
Number of pages	10
DOIs	https://doi.org/10.1097/QAD.0000000000000198
Publication status	Published - 24 Apr 2014

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title = "The origin and emergence of an HIV-1 epidemic:: from introduction to endemicity",

abstract = "Objectives: To describe, at patient-level detail, the determining events and factors involved in the development of a country's HIV-1 epidemic. Design: Clinical information for all recorded Greenlandic HIV-1 patients was analysed and correlated with both novel and previously analysed pol sequences, representing more than half of the entire Greenlandic HIV-1 epidemic. Archival blood samples were sequenced to link early infection chain descriptions to the subsequent epidemic. Methods: In-depth phylogenetic analyses were used in synergy with clinical information to assess number of introductions of HIV-1 into Greenland, the source of geographic origin, time of epidemic introduction and its epidemiological characteristics such as initial transmission chain, geographic dispersal within Greenland, method of infection, cluster size, sociological and behavioural factors. Results: Despite its small population size and isolated geographic location, data support at least 25 introductions of HIV-1 into Greenland. Only a single of these led to an epidemic. This introduction occurred between 1985 and 1986, and the epidemic cluster is still active. Facilitating factors for the emergence and spread of the epidemic cluster include a rapid transition from MSM to heterosexual spread, high prevalence of other sexually transmitted diseases, rapid dispersal to larger cities and early emergence in a distinct subpopulation with high-risk behaviour including disregard for condomizing. Conclusions: The synergistic use of disparate data categories yields such unique detail, that the Greenland epidemic now serves as a model example for the epidemic emergence of HIV-1 in a society. This renders it suitable for testing of present and future sequence-based epidemiological methodologies.",

author = "Bruhn, {Christian Anders Wathne} and Audelin, {Anne M.} and Marie Helleberg and Karen Bjorn-Mortensen and Niels Obel and Jan Gerstoft and Claus Nielsen and Mads Melbye and Patrik Medstrand and Gilbert, {M. Thomas P.} and Joakim Esbj{\"o}rnsson",

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doi = "10.1097/QAD.0000000000000198",

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T2 - from introduction to endemicity

AU - Bruhn, Christian Anders Wathne

AU - Audelin, Anne M.

AU - Helleberg, Marie

AU - Bjorn-Mortensen, Karen

AU - Obel, Niels

AU - Gerstoft, Jan

AU - Nielsen, Claus

AU - Melbye, Mads

AU - Medstrand, Patrik

AU - Gilbert, M. Thomas P.

AU - Esbjörnsson, Joakim

PY - 2014/4/24

Y1 - 2014/4/24

N2 - Objectives: To describe, at patient-level detail, the determining events and factors involved in the development of a country's HIV-1 epidemic. Design: Clinical information for all recorded Greenlandic HIV-1 patients was analysed and correlated with both novel and previously analysed pol sequences, representing more than half of the entire Greenlandic HIV-1 epidemic. Archival blood samples were sequenced to link early infection chain descriptions to the subsequent epidemic. Methods: In-depth phylogenetic analyses were used in synergy with clinical information to assess number of introductions of HIV-1 into Greenland, the source of geographic origin, time of epidemic introduction and its epidemiological characteristics such as initial transmission chain, geographic dispersal within Greenland, method of infection, cluster size, sociological and behavioural factors. Results: Despite its small population size and isolated geographic location, data support at least 25 introductions of HIV-1 into Greenland. Only a single of these led to an epidemic. This introduction occurred between 1985 and 1986, and the epidemic cluster is still active. Facilitating factors for the emergence and spread of the epidemic cluster include a rapid transition from MSM to heterosexual spread, high prevalence of other sexually transmitted diseases, rapid dispersal to larger cities and early emergence in a distinct subpopulation with high-risk behaviour including disregard for condomizing. Conclusions: The synergistic use of disparate data categories yields such unique detail, that the Greenland epidemic now serves as a model example for the epidemic emergence of HIV-1 in a society. This renders it suitable for testing of present and future sequence-based epidemiological methodologies.

AB - Objectives: To describe, at patient-level detail, the determining events and factors involved in the development of a country's HIV-1 epidemic. Design: Clinical information for all recorded Greenlandic HIV-1 patients was analysed and correlated with both novel and previously analysed pol sequences, representing more than half of the entire Greenlandic HIV-1 epidemic. Archival blood samples were sequenced to link early infection chain descriptions to the subsequent epidemic. Methods: In-depth phylogenetic analyses were used in synergy with clinical information to assess number of introductions of HIV-1 into Greenland, the source of geographic origin, time of epidemic introduction and its epidemiological characteristics such as initial transmission chain, geographic dispersal within Greenland, method of infection, cluster size, sociological and behavioural factors. Results: Despite its small population size and isolated geographic location, data support at least 25 introductions of HIV-1 into Greenland. Only a single of these led to an epidemic. This introduction occurred between 1985 and 1986, and the epidemic cluster is still active. Facilitating factors for the emergence and spread of the epidemic cluster include a rapid transition from MSM to heterosexual spread, high prevalence of other sexually transmitted diseases, rapid dispersal to larger cities and early emergence in a distinct subpopulation with high-risk behaviour including disregard for condomizing. Conclusions: The synergistic use of disparate data categories yields such unique detail, that the Greenland epidemic now serves as a model example for the epidemic emergence of HIV-1 in a society. This renders it suitable for testing of present and future sequence-based epidemiological methodologies.

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EP - 1040

JO - AIDS (London, England)

JF - AIDS (London, England)

IS - 7

ER -

The origin and emergence of an HIV-1 epidemic: from introduction to endemicity

Abstract

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