Characteristics Of Hiv-Infected Us Army Soldiers Linked In Molecular Transmission Clusters, 2001-2012

ObjectiveRecent surveillance data suggests the United States (U.S.) Army HIV epidemic is concentrated among men who have sex with men. To identify potential targets for HIV prevention strategies, the relationship between demographic and clinical factors and membership within transmission clusters based on baseline po/sequences of HIV-infected Soldiers from 2001 through 2012 were analyzed.MethodsWe conducted a retrospective analysis of baseline partial po/sequences, demographic and clinical characteristics available for all Soldiers in active service and newly-diagnosed with HIV-1 infection from January 1, 2001 through December 31, 2012. HIV-1 subtype designations and transmission clusters were identified from phylogenetic analysis of sequences. Univariate and multivariate logistic regression models were used to evaluate and adjust for the association between characteristics and cluster membership.ResultsAmong 518 of 995 HIV-infected Soldiers with available partial po/sequences, 29% were members of a transmission cluster. Assignment to a southern U.S. region at diagnosis and year of diagnosis were independently associated with cluster membership after adjustment for other significant characteristics (p<0.10) of age, race, year of diagnosis, region of duty assignment, sexually transmitted infections, last negative HIV test, antiretroviral therapy, and transmitted drug resistance. Subtyping of the po/fragment indicated HIV-1 subtype B infection predominated (94%) among HIV-infected Soldiers.ConclusionThese findings identify areas to explore as HIV prevention targets in the U.S. Army. An increased frequency of current force testing may be justified, especially among Soldiers assigned to duty in installations with high local HIV prevalence such as southern U.S. states.