Expanding HIV-1 subtype B transmission networks among men who have sex with men in Poland

<div><p>Introduction</p><p>Reconstruction of HIV transmission links allows to trace the spread and dynamics of infection and guide epidemiological interventions. The aim of this study was to characterize transmission networks among subtype B infected patients from Poland.</p><p>Material and methods</p><p>Maximum likelihood phylogenenetic trees were inferred from 966 HIV-1 subtype B protease/reverse transcriptase sequences from patients followed up in nine Polish HIV centers. Monophyletic clusters were identified using 3% within-cluster distance and 0.9 bootstrap values. Interregional links for the clusters were investigated and time from infection to onward transmission estimated using Bayesian dated MCMC phylogeny.</p><p>Results</p><p>Three hundred twenty one (33.2%) sequences formed 109 clusters, including ten clusters of ≥5 sequences (n = 81, 8.4%). Transmission networks were more common among MSM (234 sequences, 68.6%) compared to other infection routes (injection drug use: 28 (8.2%) and heterosexual transmissions: 59 (17.3%) cases, respectively [OR:3.5 (95%CI:2.6–4.6),p<0.001]. Frequency of clustering increased from 26.92% in 2009 to 50.6% in 2014 [OR:1.18 (95%CI:1.06–1.31),p = 0.0026; slope +2.8%/year] with median time to onward transmission within clusters of 1.38 (IQR:0.59–2.52) years. In multivariate models clustering was associated with both MSM transmission route [OR:2.24 (95%CI:1.38–3.65),p<0.001] and asymptomatic stage of HIV infection [OR:1.93 (95%CI:1.4–2.64),p<0.0001]. Additionally, interregional networks were linked to MSM transmissions [OR:4.7 (95%CI:2.55–8.96),p<0.001].</p><p>Conclusions</p><p>Reconstruction of the HIV-1 subtype B transmission patterns reveals increasing degree of clustering and existence of interregional networks among Polish MSM. Dated phylogeny confirms the association between onward transmission and recent infections. High transmission dynamics among Polish MSM emphasizes the necessity for active testing and early treatment in this group.</p></div

Proportions and logistic regression curves over time (2009–2014) for clusters/pairs (A, left) and clusters ≥3 sequences (B, right).

<p>Logistic regression curves are shown over the frequency bars.</p

Interregional transmission networks identified in the Bayesian MCMC analysis.

<p>Line width and shading strength reflects the number of networks between sites. Provinces participating in the study are shaded in grey.</p

Cluster frequencies by size and type of clustering.

<p>Intraregional clusters are marked in dark grey, interregional in light grey.</p

Bayesian, time-annotated MCMC phylogenetic tree of the subtype B <i>pol</i> sequences derived from clustered sequences coloured by cluster size.

<p>Clusters sized ≥5 have been enlarged. Branches used for the internode interval calculations are marked in blue. Posterior probabilities exceeding 0.7 are shown on the tree nodes.</p

Demographic, clinical and laboratory cohort characteristics associated with pairs and clusters ≥ 3 cases.

<p>Demographic, clinical and laboratory cohort characteristics associated with pairs and clusters ≥ 3 cases.</p

Patient characteristics by European region.

1<p>North:Denmark, Sweden, Netherlands, UK, West Central: Austria, Belgium, Germany, East Central: Belarus, Bosnia, Croatia, Poland, Ukraine and South: Italy and Spain.</p>2<p>IQR:Interquartile range.</p>3<p>STI: Sexually transmitted infection, LYM: Malignant lymphoma, CAN: Cervical or anal cancer/dysplasia, HZV: Herpes zoster, HEP: Hepatitis B or C, MON: Ongoing mononucleosis-like illness, CYT: Unexplained leukocytopenia/thrombocytopenia lasting >4 weeks, SEB: Seborrheic dermatitis/exanthema (SEB).</p><p>Missing data: 10 (0.3%) gender, 120 (3.3%) ethnicity, 63 (1.8%) age, 120 (3.3%) sexual orientation, 291 (8.1%) previous HIV test.</p

Prevalence of HIV-positive test by ethnicity and region.

<p>Prevalence of HIV-positive test by ethnicity and region.</p

Prevalence of HIV by indicator condition.

*<p>Unpublished prevalence data from participating study sites.</p>**<p>includes MSM, IDU prevalence.</p>***<p>UNAIDS adults aged 15–49 country HIV prevalence rate <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0052845#pone.0052845-UNAIDS2" target="_blank">[31]</a>.</p

Human Alveolar Echinococcosis in Poland: 1990–2011

<div><h3>Background</h3><p>Alveolar echinococcosis (AE) caused by <em>Echinococcus multilocularis</em> infections is a dangerous old disease in the Northern Hemisphere. The aim of the paper was to collect and analyze data on human AE in Poland in the last two decades.</p> <h3>Methodology/Principal Findings</h3><p>The sources of data were both the cases officially registered and detected by an active field and laboratory surveillance. The cases were verified by clinical, epidemiological, and laboratory criteria. Altogether 121 human cases of AE were detected. Among these 83 (68,6%) cases were classified as confirmed, 16 as probable and 22 as possible. During the two decades a continuous increase in detection rate was noticed. The cases were 6–82 years old at the time of diagnosis (mean - 47.7 years). Sex ratio M/F was 0.86/1.0. The AE was fatal in 23 (19%) patients (mean age at death - 54.1 years). Family agglomeration of AE was found in 4 foci, involving 9 patients. Seventy six of the cases were diagnosed in an advanced stage of disease. In all cases the liver was the primary location of AE. In 30 (24.8%) patients a spread to other organs was observed. Ninety four of the patients were treated with albendazole. In 73 (60%) patients a surgical operation was performed, including 15 liver transplantations.</p> <h3>Conclusions/Significance</h3><p>The studies confirmed that AE is an emerging disease in Poland, which is the fourth country in Europe with over 120 cases detected. The results also indicate the need of a wider national programme for implementation of screening in the highest AE risk areas (north-eastern Poland) with an effort to increase the public awareness of the possibility of contracting <em>E. multilocularis</em>, and above all, training of the primary care physicians in the recognition of the risk of AE to allow for an early detection of this dangerous disease.</p> </div