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A genetic analysis of a large database of UK data whose samples are from people living with HIV, proves that 18% of men with HIV who claim to be exclusively heterosexual, actually belong to groups of infections related to infection in men.
This provides a minimum value for the proportion of men with HIV in the UK are what researchers call "found only among men who have sex with men (MSM)." It is a minimum because other men who contracted HIV through sex with other men may be immersed in other groups of different affective sexual expressions.
The data were presented by Ragonnet-Cronin and colleagues of Manon at the University of Edinburgh at the Conference on Retroviruses and Opportunistic Infections last week.
In a second analysis of the same data we found that MSM were more likely links to be the binding partners between a MSM and a woman than the woman to be the link between a man and an avowed bisexual than a heterosexual man .
Phylogenetic analysis examined the 50,025 genetic sequences of HIV subtypes A1, B and C from the UK HIV Resistance Database Drug containing sequences 60% of all people with HIV in the UK (other 10.000 sequences belonging to different subtypes of HIV have not been included).
People were counted as belonging to a "group" if the HIV RNA sharing descended from a common ancestor to another person with HIV in the past five years, so for the purposes of this analysis, an "umbrella" had to include at least , three people.
There was fully 223 groups "male" containing 1204 men (average 5.4 per cluster). The total number of self-described straight men who belonged to a cluster, male-only or mixed, was 1341.
However 249 these heterosexual men allegedly belonged effectively to all male groups, which means that 18% of heterosexual men were in fact probably not disclosed MSM (ndHSH).
these ndHSH * Na (not disclosed) They were considerably more likely to be of black African ethnicity rather than any other ethnic group. They were also much less likely to have had a recent HIV infection: only 12,5% had a recent infection versus 75% of MSM declared. This could mean two things, both of which might be true: ndHSH are much more likely to be late presenters and can also be older than declared MSM.
The ndHSH were much more likely to be peripheral rather than central groups. They were twice as likely as the edge is declared MSM groups, ie only connected thereto through a partner. This implies that they have fewer partners and may be less likely to transmit HIV.
But they were also highly "embrace collected in the field," meaning that they were much more likely to be linked to other ndHSH than the mixture was random, and if they were linked to more than one partner, was much more likely at least one other was ndHSH.
This analysis only puts the measures supposedly heterosexual men who had only male contacts. However there was concern from the beginning of the epidemic that bisexual men, which could have link between gay population and the general population. This proved not to be a major problem in countries with epidemics concentrated but can become a factor in countries with generalized epidemics.
The researchers thus made an analysis of the few groups of three or more people on the network where "bridges" between declared MSM and men or heterosexual women did not happen.
They told two types of joint. In one, the woman was a link between an openly bisexual MSM and heterosexual men, that is, it seemed likely to have received their infection from one and passed it to another. In the second, a man who said he was was a link between heterosexuals of a declared MSM and a woman and probably captured from a HIV passed to the other. Note that none of these settings can show who infected that: establishing thesenseinfection in phylogenetic analysis is much more difficult than demonstrating the joint.
The configuration with which the man in the middle and was therefore most likely a non-disclosed MSM was 2,24 times more likely than where the woman was in the middle. 1341 of heterosexual men in groups, 54 (4%) associated with women MSM In contrast only 32 1711 out of Women in groups (1,9%) were the link between a person declared MSM and heterosexual men.
This study provides a considerably higher estimate the proportion of "heterosexual men with HIV in the UK are in fact in a previous study in the year 2014. HSH reserved. This estimate of the proportion of 6%, although estimate that the proportion of ndHSH among black Africans was raised to 21%. However this study only looked at the B subtype of HIV infections, and would therefore tend to lose more infections in non-whites, which aresusceptiblehave other subtypes.
It would be interesting to see an analysis of all subtypes, which include subtype D (also common in parts of eastern Africa, and increasingly in the Middle East) and AE subtype (which is the predominant type in both heterosexual and MSM in Southeast Asia ).
Translated by Claudio Souza's originalOne in five 'heterosexual' men in the UK Their caught HIV from another manon Aidsmap
Reviewed by Penny Lane