We examined baseline HIV-1
protease and reverse transcriptase sequences and HIV clinical parameters from
1021 consecutive patients (814 male, 207 female) through the Royal Perth
Hospital HIV service, to investigate HIV-1 subtype diversity and local
phylogenetic networks from 2000-2014. HIV-1 subtype B virus sequences were
demonstrated in 619 (61%) of cases, with increasing non-B HIV-1 subtypes from
23.2% (2000-2003) to 48% (2008-2011) and 43% (2012-2014) (p<0.001),
including CRF01_AE subtype (6.6% (2000-2003) to 21.5% (2008-2011)) and HIV-1 C
subtype (9.5% (2000-2003) to 20.2% (2008-2011)).
More HIV-1 B subtypes were
assigned to phylogenetic clusters compared to non-B subtypes (34% vs 18%;
p<0.001), with larger clusters identified (cluster size>2: 135/211; 64%
versus 13/69; 19%; p=0.001), including one cluster of 53 HIV-1 B subtype
sequences that evolved from 2008-2014. Non-B subtype HIV-1 was associated with
lower baseline CD4 T cell count (p=0.005) but not plasma HIV-1 RNA levels
(p=0.31), suggesting relatively delayed diagnosis. Baseline viral load was
strongly associated with calendar time (mean 18,620 copies/ml in 2000-2003;
75,858 copies/mL in 2012-2014 (p<0.001), and was also associated with larger
phylogenetic clusters (size>2) in adjusted analyses (p=0.03).
This study
identifies a number of temporal trends over the past 15 years, including an
increasing prevalence of non-B subtype HIV-1 that highlights the growing
influence of migration and travel on the Australian HIV-1 epidemic and the
associated increased role of heterosexual HIV-1 transmission in this context.
At the same time, these data indicate that local transmission within
predominantly male networks remains a challenging issue for HIV-1 prevention.
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By:
- 1Royal Perth Hospital, Clinical Immunology , Level2 North Block , Wellington st , PERTH , Perth, Western Australia, Australia , 6000 , +61 08 92242899 , +61 08 92242920.
- 2Murdoch University, School of Veterinary and Life Sciences, Perth, Western Australia, Australia ; allison.castley@health.wa.gov.au.
- 3Murdoch University, Institute of Immunology and Infectious Diseases , Perth, Western Australia, Australia.
- 4University of Western Australia, School of Anatomy, Physiology and Human Biology , Perth, Western Australia, Australia.
- 5Vanderbilt University, Department of Medicine, Nashville, Tennessee, United States ; silvana.gaudieri@uwa.edu.au.
- 6Murdoch University, Clinical Immunology and Biomedical Statistics , South Street , Murdoch , Perth, Western Australia, Australia , 6150.
- 7Australia ; I.James@murdoch.edu.au.
- 8Royal Perth Hospital, Clinical Immunology , Level2 North Block , Wellington st , PERTH , Perth, Western Australia, Australia , 6000 , +61 08 92242899 , +61 08 92242920 ; laila.gizzarelli@health.wa.gov.au.
- 9Royal Perth Hospital, Clinical Immunology , Level2 North Block , Wellington st , PERTH , Perth, Western Australia, Australia , 6000 , +61 08 92242899 , +61 08 92242920 ; George.Guelfi@health.wa.gov.au.
- 10Royal Perth Hospital, Clinical Immunology, Perth, Western Australia, Australia.
- 11Murdoch University, Institute of Immunology and Infectious Diseases , Perth, Western Australia, Australia ; m.john@iiid.murdoch.edu.au.
- 12Murdoch University, Institute of Immunology and Infectious Diseases , Perth, Western Australia, Australia ; d.nolan@iiid.com.au.
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