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Recent and rapid transmission of HIV among people who inject drugs in Scotland revealed through phylogenetic analysis

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    Rights statement: This is a pre-copyedited, author-produced version of an article accepted for publication in 'Recent and Rapid Transmission of HIV Among People Who Inject Drugs in Scotland Revealed Through Phylogenetic Analysis' following peer review. The version of record Manon Ragonnet-Cronin, Celia Jackson, Amanda Bradley-Stewart, Celia Aitken, Andrew McAuley, Norah Palmateer, Rory Gunson, David Goldberg, Catriona Milosevic, Andrew J Leigh Brown, Recent and Rapid Transmission of HIV Among People Who Inject Drugs in Scotland Revealed Through Phylogenetic Analysis, The Journal of Infectious Diseases, Volume 217, Issue 12, 15 June 2018, Pages 1875–1882, https://doi.org/10.1093/infdis/jiy130 is available online at: https://doi.org/10.1093/infdis/jiy130

    Accepted author manuscript, 857 KB, PDF document

Original languageEnglish
Pages (from-to)1875-1882
Number of pages8
JournalThe Journal of Infectious Diseases
Issue number12
Publication statusPublished - 10 Apr 2018


Background: Harm reduction has dramatically reduced HIV incidence among people who inject drugs (PWID). In Glasgow, Scotland, <10 infections/year have been diagnosed among PWID since the mid-1990s. However, in 2015 a sharp rise in diagnoses was noted among PWID; many were subtype C with 2 identical drug-resistant mutations and some displayed low avidity, suggesting the infections were linked and recent.

Methods: We collected Scottish pol sequences and identified closely related sequences from public databases. Genetic linkage was ascertained among 228 Scottish, 1820 UK, and 524 global sequences. The outbreak cluster was extracted to estimate epidemic parameters.

Results: All 104 outbreak sequences originated from Scotland and contained E138A and V179E. Mean genetic distance was <1% and mean time between transmissions was 6.7 months. The average number of onward transmissions consistently exceeded 1, indicating that spread was ongoing.

Conclusions: In contrast to other recent HIV outbreaks among PWID, harm reduction services were not clearly reduced in Scotland. Nonetheless, the high proportion of individuals with a history of homelessness (45%) suggests that services were inadequate for those in precarious living situations. The high prevalence of hepatitis C (>90%) is indicative of sharing of injecting equipment. Monitoring the epidemic phylogenetically in real time may accelerate public health action.

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