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Oral Presentations
O19 – MODELS, NETWORKS AND TRANSMISSION DYNAMICS: NEW INSIGHTS FOR PROGRAMS
Wednesday, July 17, 2019 1:45 PM – 3:15 PM
O19.4 Molecular epidemiology of HIV among foreign-born residents of king county, washington, USA, using HIV surveillance data
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  1. Diana Tordoff1,
  2. Joshua Herbeck2,
  3. Susan Buskin3,
  4. Richard Lechtenberg3,
  5. Matthew Golden4,
  6. Roxanne Kerani5
  1. 1University of Washington, Department of Epidemiology, Seattle, USA
  2. 2University of Washington, Department of Global Health, Seattle, USA
  3. 3Public Health – Seattle and King County, Seattle, USA
  4. 4University of Washington, Medicine, Seattle, USA
  5. 5Public Health – Seattle and King County, HIV/STD Program, Seattle, USA

Abstract

Background In King County, one-third of HIV diagnoses occur among foreign-born individuals, a 50% increase since 2010. The extent to which these infections are locally acquired is unclear, but has important implications for HIV prevention and incidence estimation.

Methods Using HIV surveillance (2010–2018) and partner services (PS) (2010–2016) data from Public Health–Seattle & King County, HIV-1 pol gene sequences from routine drug resistance testing were linked to demographic, clinical, and epidemiological information. We identified genetic similarity clusters of 2+ individuals using TN93 pairwise genetic distance with a 0.02 threshold. Belonging to a cluster is suggestive of local transmission, therefore correlates of clustering were identified using logistic regression, adjusted for early infection (CD4 >500 cells/mm at diagnosis). We also calculated the proportion of foreign-born cases with a negative HIV test in the U.S. before diagnosis.

Results From 2010–2018, 2,521 people were diagnosed with HIV in King County: 663 (26%) occurred among foreign-born individuals, primarily from Latin America (N=232), sub-Saharan Africa (SSA) (N=214), and Asia (N=98). Among individuals with a PS interview (75% Latin American, 56% SSA, 69% Asian-born), HIV testing histories suggest that 40% of Latin American, 19% of SSA, and 36% of Asian-born individuals likely acquired HIV locally. Individuals with non-B HIV subtypes similarly varied by region of birth: 2% of US, 5% of Latin American, 93% of SSA, and 46% of Asian-born people. Among 1,754 individuals with an available sequence (70% of U.S. versus 63% of foreign-born), 1,092 (62%) clustered in 304 genetically similar clusters. Odds of clustering, compared to US-born, was 0.44 (95%CI: 0.31,0.60) among Latin American, 0.08 (95%CI: 0.05,0.14) among SSA, and 0.40 (95%CI: 0.24,0.66) among Asian-born.

Conclusion Our results suggest that local HIV acquisition occurs least frequently among SSA-born, followed by Asian-born and Latin American immigrants. Incident estimates that include all diagnoses among foreign-born people may overestimate HIV incidence.

Disclosure No significant relationships.

  • HIV

https://doi.org/10.1136/sextrans-2019-sti.213

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