Drivers of HIV-1 transmission: the Portuguese case

Background Portugal has one of the most severe HIV-1 epidemic in Western Europe. Two subtypes circulate in parallel since the beginning of the epidemic. Comparing their transmission patterns and its association with transmitted drug resistance (TDR) is important to pinpoint transmission hotspots and to develop evidence-based treatment guidelines. Methods 3599 HIV-1 naive patients collected between 2001 and 2014 were included in the study. Sequences obtained from drug resistance testing were used for subtyping, TDR determination and transmission clusters (TC) analyses. Results Subtype B transmission was significantly associated with young males, while subtype G was associated with older heterosexuals. Young males infected with subtype B were more likely to be included in TC. Consistently, a decreasing trend of prevalence and transmission of subtype G in Portuguese originated people was observed. Active TCs were associated with subtype B-infected males residing in Lisbon. TDR was significantly different when comparing subtypes B (10.8% [9.5-12.2]) and G (7.6% [6.4-9.0]) (p=0.001). Discussion TC analyses shows that the subtype B epidemic is active and fueled by young male patients residing in Lisbon and that transmission of subtype G in Portugal is decreasing. Despite similar treatment rates for both subtypes in Portugal, TDR is different between subtypes.