@article {20362,
	title = {HIV-1 molecular transmission clusters in nine European countries and Canada: association with demographic and clinical factors},
	journal = {BMC MedBMC MedBMC Med},
	volume = {17},
	number = {1},
	year = {2019},
	note = {1741-7015Paraskevis, DimitriosBeloukas, ApostolosOrcid: 0000-0001-5639-0528Stasinos, KostantinosPantazis, Nikosde Mendoza, CarmenBannert, NorbertMeyer, LaurenceZangerle, RobertGill, JohnPrins, Mariad{\textquoteright}Arminio Montforte, AntonellaKran, Anne-Marte BakkenPorter, KholoudTouloumi, GiotaCASCADE collaboration of EuroCoordMC_U122886351/Medical Research Council/United KingdomMC_UU_12023/15/Medical Research Council/United KingdomJournal ArticleResearch Support, Non-U.S. Gov{\textquoteright}tBMC Med. 2019 Jan 8;17(1):4. doi: 10.1186/s12916-018-1241-1.},
	month = {Jan 8},
	pages = {4},
	edition = {2019/01/09},
	abstract = {BACKGROUND: Knowledge of HIV-1 molecular transmission clusters (MTCs) is important, especially in large-scale datasets, for designing prevention programmes and public health intervention strategies. We used a large-scale HIV-1 sequence dataset from nine European HIV cohorts and one Canadian, to identify MTCs and investigate factors associated with the probability of belonging to MTCs. METHODS: To identify MTCs, we applied maximum likelihood inferences on partial pol sequences from 8955 HIV-positive individuals linked to demographic and clinical data. MTCs were defined using two different criteria: clusters with bootstrap support >75\% (phylogenetic confidence criterion) and clusters consisting of sequences from a specific region at a proportion of >75\% (geographic criterion) compared to the total number of sequences within the network. Multivariable logistic regression analysis was used to assess factors associated with MTC clustering. RESULTS: Although 3700 (41\%) sequences belonged to MTCs, proportions differed substantially by country and subtype, ranging from 7\% among UK subtype C sequences to 63\% among German subtype B sequences. The probability of belonging to an MTC was independently less likely for women than men (OR = 0.66; P < 0.001), older individuals (OR = 0.79 per 10-year increase in age; P < 0.001) and people of non-white ethnicity (OR = 0.44; P < 0.001 and OR = 0.70; P = 0.002 for black and {\textquoteright}other{\textquoteright} versus white, respectively). It was also more likely among men who have sex with men (MSM) than other risk groups (OR = 0.62; P < 0.001 and OR = 0.69; P = 0.002 for people who inject drugs, and sex between men and women, respectively), subtype B (ORs 0.36-0.70 for A, C, CRF01 and CRF02 versus B; all P < 0.05), having a well-estimated date of seroconversion (OR = 1.44; P < 0.001), a later calendar year of sampling (ORs 2.01-2.61 for all post-2002 periods versus pre-2002; all P < 0.01), and being na{\"\i}ve to antiretroviral therapy at sampling (OR = 1.19; P = 0.010). CONCLUSIONS: A high proportion (>40\%) of individuals belonged to MTCs. Notably, the HIV epidemic dispersal appears to be driven by subtype B viruses spread within MSM networks. Expansion of regional epidemics seems mainly associated with recent MTCs, rather than the growth of older, established ones. This information is important for designing prevention and public health intervention strategies.},
	keywords = {(NIS-23-01-05/ 2006). Italian cohort: Local ethical committees from all sites, *Clusters, *Hiv, *HIV epidemic, *Molecular Epidemiology, *Phylogenies, *Regional epidemics, *Transmission networks, 006, 0132246/67GP, 1.2006.1811 -, 111/350, 115/2007, 125/2007/0/OSS, 1272, 1296/08, 1926/32/07, 1932, 20/16)., 2070211, 217/CEP, 24781, 261/07/CE, 263/CELAZIO1, 26547, 29/CE, 3039/CE, 32/2007, 348/L, 35-2016, 3617, 38/2007, 3811/AO/16, 42847, 44 CE/MA/CM, 51460, 5522/08-RN/RV, 589/A1376/CE/2007, 60/INT/CEI/11263, 63687, 7713/R, 7925/16, 857/D, 98/07, Adult, affiliations., all participating cohorts: Austrian participating centres: Ethikkommission der, Athens, Berlin (EA2/105/05). Greek cohort (AMACS {\textendash} Athens Multicenter AIDS Cohort Study):, Canada/epidemiology, CE/38/14, cohort: Comite de protection des Personnes ile de France II (Am7323-13-1157). German, committees that provided approval can be found in the in Additional~file~3. CONSENT, contributing to the cohort (10/08/69/07 AP, Council{\textendash}University College London (UCL), UK, outside of the submitted work. JG has, Enrolled study patients gave written informed consent. A full list of the ethics, Epidemics, Ethikkommission der, Ethikkommission der Medizinischen, Ethikkommission des Landes Oberosterreich (C-3-10), Ethikkommission fur das Bundesland Salzburg (415-E/1159/4-2010), Europe/epidemiology, European Union (EU) Framework Programme 7 (FP7) through the Medical Research, Female, FOR PUBLICATION: Not applicable. COMPETING INTERESTS: AB received an ΙΚΥ Fellowship, Gilead and ViiV, outside of the submitted work. KP received funding from EU FP7, Gilead Sciences Europe, outside of the submitted work. All other authors declare, HIV Infections/*epidemiology/*genetics/*transmission, HIV Seropositivity/epidemiology, HIV-1 Seroconverter Cohort: The ethical committee of the Charit{\'e} University Medicine, HIV-1/*genetics, Humans, Instituto de Salud Carlos III (ISCIII) (CEI PI 01_2012-v2). UK registry: The West, LM has received grants from ANRS, Fondation de la Recherche M{\'e}dicale, and the, Male, Medical Bioethics committee, Calgary Alberta Canada (REB15-0929_REN4 2). French, Medisinsk og Helsefaglig Forskningstetikk (REK) (2016/892/REK, Medizinische Universitat Graz (21-431 ex09/10), Medizinischen Universitat Wien (898/2010). Canada registry: University of Calgary, Middle Aged, Midlands {\textendash} South Birmingham National Research Ethics Service (04/G2707/155)., Netherlands registry: the Medical Ethical Committee of the Amsterdam Medical Centre,, neutral with regard to jurisdictional claims in published maps and institutional, of Excellence for Postdoctoral Research in Greece {\textendash} Siemens Program for this work., Phylogeny, Prevention and Control, the EU, UCL, EU structural funds and National Funds and, received honoraria as an ad hoc member of the national HIV advisory boards of Merck,, RP/246/CE, S-0885). Spain cohort: Comit{\'e} de {\'E}tica de la Investigaci{\'o}n y de Bienestar Animal del, Sharp and Dohme, outside of the submitted work. GT received funding from the EU, that they have no competing interests. PUBLISHER{\textquoteright}S NOTE: Springer Nature remains, The Hellenic Center for Diseases Control and Prevention (4090/2005), the Netherlands (07/182 and 09/040). Norwegian cohort: Regionale Komiteer for, Universitat Innsbruck (283/4.4), University Medical School EC (319/2005) and the National Organization of Medicines, V2016, while conducting this study, as well as grants from the European Centre for Disease, while conducting this study, as well as honoraria from ViiV Healthcare and Merck,},
	isbn = {1741-7015},
	author = {Paraskevis, D and Beloukas, A. and Stasinos, K. and Pantazis, N. and de Mendoza, C and Bannert, N. and Meyer, L. and Zangerle, R. and Gill, J. and Prins, M. and d{\textquoteright}Arminio Montforte, A. and Kran, A. B. and Porter, K. and Touloumi, G.}
}
