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Epidemiology of HIV-1 Subtypes Among Men Who Have Sex With Men in Cape Town, South Africa

Middelkoop, Keren MBChB, PhD*,†; Rademeyer, Cecilia MSc‡,§; Brown, Ben B. BSc*,†; Cashmore, Tamaryn J. BMedSc‡,§; Marais, Jinny C. MSc‡,§; Scheibe, Andrew P. MBChB*,†; Bandawe, Gama P. MSc‡,§; Myer, Landon MBChB, PhD*,†,‖; Fuchs, Jonathan D. MD, MPH¶,#; Williamson, Carolyn PhD‡,§,**; Bekker, Linda-Gail MBChB, FCP, PhD*,†

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 1st, 2014 - Volume 65 - Issue 4 - p 473–480
doi: 10.1097/QAI.0000000000000067
Epidemiology and Prevention

Objective: Early studies in Cape Town identified independent HIV-1 epidemics, with distinct viral subtypes, among men who have sex with men (MSM) and the heterosexual population. However, few recent HIV-1 subtype data are available for MSM in South Africa. We examined HIV-1 subtypes among MSM in Cape Town.

Design: Cross-sectional survey.

Methods: Self-identified MSM were recruited from geographically and racially disparate communities across Cape Town. Participants completed behavioral questionnaires and underwent HIV testing. Virus isolated from infected participants underwent complete env gp160 sequencing, and HIV-1 subtypes were assigned through phylogenetic analysis.

Results: In total, 194 HIV-infected MSM were enrolled: 67% black African, 24% colored, and 9% white men. More black African men identified as bisexual or heterosexual compared with other races. Overall, 31%–66% of men reported a recent partner of another race. HIV-1 subtypes were confirmed for 143 participants: 81% were subtype C, 14% B, 1% A1, 1% F2, and 3 recombinant viruses. Subtype C virus was associated with black African race (P = 0.003 compared with colored; P < 0.001 compared with white), men who identified as bisexual/heterosexual (P = 0.01), and reported a female sexual partner in the last year (P = 0.02). Compared with previous studies, an increasing prevalence of subtype C virus was noted among white MSM.

Conclusions: This molecular epidemiology study provides novel evidence of sexual network links between the heterosexual and MSM epidemics and between historically racially disparate communities. These findings provide insights into the drivers of HIV epidemics in different population groups and may have implications for prevention strategies.

*Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and

Department of Medicine, University of Cape Town, Cape Town, South Africa;

Division of Medical Virology and

§Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa;

Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa;

Center for Learning and Innovation, San Francisco Department of Public Health, San Francisco, CA;

#University of California, San Francisco; and

**National Health Laboratory Services, Cape Town, South Africa.

Correspondence to: Keren Middelkoop, MBChB, PhD, Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, PO Box 13801, Mowbray, Observatory, Cape Town, 7705, South Africa (e-mail: keren.middelkoop@hiv-research.org.za).

Supported by the International AIDS Vaccine Initiative, the Developmental Center for AIDS Research at the University of Rochester, and US Centers for Disease Control and Prevention, with funding from the President's Emergency Plan for AIDS Relief. K.M. was supported by a Hasso Plattner Foundation award through the University of Cape Town.

Preliminary results presented at the Sixth IAS Conference on HIV Pathogenesis, Treatment and Prevention, July 17–20, 2011, Rome, Italy. Abstract MOPE034; A00220 on Abstract CD.

The authors have no conflicts of interest to disclose.

K.M.: Study conception and design, analysis and interpretation of data, drafting the article, and final approval of the article. C.R.: Processing of specimens and interpretation of data, assistance with drafting the article, critical revision of article for important intellectual content, and final approval of the article. B.B. and A.S.: Acquisition of data, critical revision of article for important intellectual content, and final approval of the article. T.B. and J.M.: Processing of specimens, critical revision of article for important intellectual content, and final approval of the article. G.B.: Establishment of laboratory methodology, processing of specimens, critical revision of article for important intellectual content, and final approval of the article. L.M.: Study conception and design, critical revision of article for important intellectual content, and final approval of the article. J.F.: Study design, critical revision of article for important intellectual content and final approval of the article. C.W.: Interpretation of data, critical revision of article for important intellectual content, and final approval of the article. L.G.B.: Study conception and design, interpretation of data, critical revision of article for important intellectual content, and final approval of the article.

Received November 05, 2013

Accepted November 05, 2013

© 2014 by Lippincott Williams & Wilkins