1
|
Switzer WM, Shankar A, Jia H, Knyazev S, Ambrosio F, Kelly R, Zheng H, Campbell EM, Cintron R, Pan Y, Saduvala N, Panneer N, Richman R, Singh MB, Thoroughman DA, Blau EF, Khalil GM, Lyss S, Heneine W. High HIV diversity, recombination, and superinfection revealed in a large outbreak among persons who inject drugs in Kentucky and Ohio, USA. Virus Evol 2024; 10:veae015. [PMID: 38510920 PMCID: PMC10953796 DOI: 10.1093/ve/veae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 03/22/2024] Open
Abstract
We investigated transmission dynamics of a large human immunodeficiency virus (HIV) outbreak among persons who inject drugs (PWID) in KY and OH during 2017-20 by using detailed phylogenetic, network, recombination, and cluster dating analyses. Using polymerase (pol) sequences from 193 people associated with the investigation, we document high HIV-1 diversity, including Subtype B (44.6 per cent); numerous circulating recombinant forms (CRFs) including CRF02_AG (2.5 per cent) and CRF02_AG-like (21.8 per cent); and many unique recombinant forms composed of CRFs with major subtypes and sub-subtypes [CRF02_AG/B (24.3 per cent), B/CRF02_AG/B (0.5 per cent), and A6/D/B (6.4 per cent)]. Cluster analysis of sequences using a 1.5 per cent genetic distance identified thirteen clusters, including a seventy-five-member cluster composed of CRF02_AG-like and CRF02_AG/B, an eighteen-member CRF02_AG/B cluster, Subtype B clusters of sizes ranging from two to twenty-three, and a nine-member A6/D and A6/D/B cluster. Recombination and phylogenetic analyses identified CRF02_AG/B variants with ten unique breakpoints likely originating from Subtype B and CRF02_AG-like viruses in the largest clusters. The addition of contact tracing results from OH to the genetic networks identified linkage between persons with Subtype B, CRF02_AG, and CRF02_AG/B sequences in the clusters supporting de novo recombinant generation. Superinfection prevalence was 13.3 per cent (8/60) in persons with multiple specimens and included infection with B and CRF02_AG; B and CRF02_AG/B; or B and A6/D/B. In addition to the presence of multiple, distinct molecular clusters associated with this outbreak, cluster dating inferred transmission associated with the largest molecular cluster occurred as early as 2006, with high transmission rates during 2017-8 in certain other molecular clusters. This outbreak among PWID in KY and OH was likely driven by rapid transmission of multiple HIV-1 variants including de novo viral recombinants from circulating viruses within the community. Our findings documenting the high HIV-1 transmission rate and clustering through partner services and molecular clusters emphasize the importance of leveraging multiple different data sources and analyses, including those from disease intervention specialist investigations, to better understand outbreak dynamics and interrupt HIV spread.
Collapse
Affiliation(s)
- William M Switzer
- Division of HIV Prevention, CDC, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Anupama Shankar
- Division of HIV Prevention, CDC, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Hongwei Jia
- Division of HIV Prevention, CDC, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Sergey Knyazev
- Division of HIV Prevention, CDC, 1600 Clifton Rd, Atlanta, GA 30329, USA
- Oak Ridge Institute for Science and Education, 1299 Bethel Valley Rd, Oak Ridge, TN 37830, USA
| | - Frank Ambrosio
- Division of HIV Prevention, CDC, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Reagan Kelly
- Division of HIV Prevention, CDC, 1600 Clifton Rd, Atlanta, GA 30329, USA
- General Dynamics Information Technology, 3150 Fairview Park Dr, Falls Church, VA 22042, USA
| | - HaoQiang Zheng
- Division of HIV Prevention, CDC, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | | | - Roxana Cintron
- Division of HIV Prevention, CDC, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Yi Pan
- Division of HIV Prevention, CDC, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | | | - Nivedha Panneer
- Division of HIV Prevention, CDC, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Rhiannon Richman
- HIV Surveillance Program, Bureau of HIV/STI/Viral Hepatitis, Ohio Department of Health, 246 North High Street, Colombus, OH 43215, USA
| | - Manny B Singh
- Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort, KY 40621, USA
| | - Douglas A Thoroughman
- Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort, KY 40621, USA
- ORR/Division of State and Local Readiness/Field Services Branch/CEFO Program, CDC, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Erin F Blau
- Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort, KY 40621, USA
- Epidemic Intelligence Service, CDC, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - George M Khalil
- Division of HIV Prevention, CDC, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Sheryl Lyss
- Division of HIV Prevention, CDC, 1600 Clifton Rd, Atlanta, GA 30329, USA
- HIV Surveillance Program, Bureau of HIV/STI/Viral Hepatitis, Ohio Department of Health, 246 North High Street, Colombus, OH 43215, USA
- Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort, KY 40621, USA
- Hamilton County Public Health, 250 William Howard Taft Rd, Cincinnati, OH 45219, USA
- Northern Kentucky Health Department, 8001 Veterans Memorial Drive, Florence, KY 41042, USA
| | - Walid Heneine
- Division of HIV Prevention, CDC, 1600 Clifton Rd, Atlanta, GA 30329, USA
| |
Collapse
|
2
|
Genetic characteristics of HIV-1 CRF06_cpx and CRF56_cpx strains isolated in Guangzhou, China. Arch Virol 2021; 166:2853-2857. [PMID: 34373969 DOI: 10.1007/s00705-021-05198-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
Strains of the HIV-1 circulating recombinant forms (CRFs) 06_cpx and 56_cpx were identified for the first time in Guangzhou, China. The nearly full-length genome (NFLG) sequence was amplified, and the PCR products were sequenced by the Sanger method. The CRF06_cpx and CRF56_cpx strains were identified using the Basic Local Alignment Search Tool (BLAST) and confirmed by neighbour-joining (NJ) phylogenetic analysis. Additionally, these strains were found to contain transmitted drug resistance mutations that have little effect on first-line efavirenz (EFV)-based treatment. Genetic analysis of the detailed sequence data will provide more information on the HIV-1 epidemic in China.
Collapse
|
3
|
Nduva GM, Nazziwa J, Hassan AS, Sanders EJ, Esbjörnsson J. The Role of Phylogenetics in Discerning HIV-1 Mixing among Vulnerable Populations and Geographic Regions in Sub-Saharan Africa: A Systematic Review. Viruses 2021; 13:1174. [PMID: 34205246 PMCID: PMC8235305 DOI: 10.3390/v13061174] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 12/19/2022] Open
Abstract
To reduce global HIV-1 incidence, there is a need to understand and disentangle HIV-1 transmission dynamics and to determine the geographic areas and populations that act as hubs or drivers of HIV-1 spread. In Sub-Saharan Africa (sSA), the region with the highest HIV-1 burden, information about such transmission dynamics is sparse. Phylogenetic inference is a powerful method for the study of HIV-1 transmission networks and source attribution. In this review, we assessed available phylogenetic data on mixing between HIV-1 hotspots (geographic areas and populations with high HIV-1 incidence and prevalence) and areas or populations with lower HIV-1 burden in sSA. We searched PubMed and identified and reviewed 64 studies on HIV-1 transmission dynamics within and between risk groups and geographic locations in sSA (published 1995-2021). We describe HIV-1 transmission from both a geographic and a risk group perspective in sSA. Finally, we discuss the challenges facing phylogenetic inference in mixed epidemics in sSA and offer our perspectives and potential solutions to the identified challenges.
Collapse
Affiliation(s)
- George M. Nduva
- Department of Translational Medicine, Lund University, 205 02 Malmö, Sweden; (G.M.N.); (J.N.); (A.S.H.)
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi 80108, Kenya;
| | - Jamirah Nazziwa
- Department of Translational Medicine, Lund University, 205 02 Malmö, Sweden; (G.M.N.); (J.N.); (A.S.H.)
| | - Amin S. Hassan
- Department of Translational Medicine, Lund University, 205 02 Malmö, Sweden; (G.M.N.); (J.N.); (A.S.H.)
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi 80108, Kenya;
| | - Eduard J. Sanders
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi 80108, Kenya;
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, The University of Oxford, Oxford OX1 2JD, UK
| | - Joakim Esbjörnsson
- Department of Translational Medicine, Lund University, 205 02 Malmö, Sweden; (G.M.N.); (J.N.); (A.S.H.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, The University of Oxford, Oxford OX1 2JD, UK
| |
Collapse
|
4
|
Pérez-Parra S, Álvarez M, Fernandez-Caballero JA, Pérez AB, Santos J, Bisbal O, Aguilera A, Rivero M, García-Fraile L, García F. Continued propagation of the CRF19_cpx variant among HIV-positive MSM patients in Spain. J Antimicrob Chemother 2019; 73:1031-1038. [PMID: 29325134 DOI: 10.1093/jac/dkx474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/15/2017] [Indexed: 01/15/2023] Open
Abstract
Objectives The HIV-1 CRF19_cpx genetic form has been recently associated with greater pathogenicity. We used CoRIS, a national cohort of 31 reference hospitals in Spain, to investigate the current epidemiological situation of this variant in Spain. Patients and methods We analysed 4734 naive HIV-1-positive patients diagnosed during the 2007-15 period with an available pol gene sequence in the CoRIS resistance database. HIV-1 CRF19_cpx was ascribed through REGA3.0 and confirmed by a phylogenetic analysis. We analysed the presence of the transmission clusters of HIV-1 CRF19_cpx by maximum likelihood [with the randomized accelerated maximum likelihood (RAxML) program] and the time to the most recent common ancestor using Bayesian inference (BEAST, v. 1.7.5). Results Nineteen patients were infected with CRF19_cpx: all were male, they had a mean age of 42.9 years (95% CI: 36.4-52.5 years), the majority were MSM [n = 18 (95%)] and of Spanish nationality [n = 16 (84.2%)] and they had high CD4+ T cell counts (∼415 cells/mm3). Fifteen patients were grouped into four different transmission clusters: two clusters (two patients each) grouped the patients from Valencia and another cluster grouped one patient from Madrid and another from Seville. We found a larger cluster that grouped nine patients from southern Spain (Malaga and Seville), of which six presented mutation G190A. We estimated the origin of all the transmission clusters to take place between 2009 and 2010. Conclusions We demonstrate that this variant has spread in Spain in recent years among young HIV-positive MSM and we note a recent expansion in southern Spain in patients who carry mutation G190A. We alert healthcare managers to enhance preventive measures to prevent the continuous spread of HIV-1 CRF19_cpx.
Collapse
Affiliation(s)
- S Pérez-Parra
- Clinical Microbiology & Infectious Disease Unit, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - M Álvarez
- Clinical Microbiology & Infectious Disease Unit, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - J A Fernandez-Caballero
- Clinical Microbiology & Infectious Disease Unit, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - A B Pérez
- Clinical Microbiology & Infectious Disease Unit, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - J Santos
- Infectious Diseases Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - O Bisbal
- Infectious Diseases Unit, Hospital 12 de Octubre, Madrid, Spain
| | - A Aguilera
- Clinical Microbiology Dept, Complexo Hospitalario Santiago de Compostela, Spain
| | - M Rivero
- Infectious Diseases Unit, Hospital de Navarra, Pamplona, Spain
| | - L García-Fraile
- Infectious Diseases Unit, Hospital de la Princesa, Madrid, Spain
| | - F García
- Clinical Microbiology & Infectious Disease Unit, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| |
Collapse
|
5
|
Patiño-Galindo JÁ, González-Candelas F. The substitution rate of HIV-1 subtypes: a genomic approach. Virus Evol 2017; 3:vex029. [PMID: 29942652 PMCID: PMC6007745 DOI: 10.1093/ve/vex029] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
HIV-1M causes most infections in the AIDS pandemic. Its genetic diversity is defined by nine pure subtypes and more than sixty recombinant forms. We have performed a comparative analysis of the evolutionary rate of five pure subtypes (A1, B, C, D, and G) and two circulating recombinant forms (CRF01_AE and CRF02 AG) using data obtained from nearly complete genome coding sequences. Times to the most recent common ancestor (tMRCA) and substitution rates of these HIV genomes, and their genomic partitions, were estimated by Bayesian coalescent analyses. Genomic substitution rate estimates were compared between the HIV-1 datasets analyzed by means of randomization tests. Significant differences in the rate of evolution were found between subtypes, with subtypes C and A1 and CRF01_AE displaying the highest rates. On the other hand, CRF02_AG and subtype D were the slowest evolving types. Using a different molecular clock model for each genomic partition led to more precise tMRCA estimates than when linking the same clock along the HIV genome. Overall, the earliest tMRCA corresponded to subtype A1 (median = 1941, 95% HPD = 1943-55), whereas the most recent tMRCA corresponded to subtype G and CRF01_AE subset 3 (median = 1971, 95% HPD = 1967-75 and median = 1972, 95% HPD = 1970-75, respectively). These results suggest that both biological and epidemiological differences among HIV-1M subtypes are reflected in their evolutionary dynamics. The estimates obtained for tMRCAs and substitution rates provide information that can be used as prior distributions in future Bayesian coalescent analyses of specific HIV-1 subtypes/CRFs and genes.
Collapse
Affiliation(s)
- Juan Ángel Patiño-Galindo
- Unidad Mixta Infección y Salud Pública FISABIO-Salud Pública/Universitat de València, Institute for Integrative Systems Biology (I2SysBio), CIBERESP, c/Catedratico Jose Beltran, 2, 46980 Paterna, Valencia, Spain
| | - Fernando González-Candelas
- Unidad Mixta Infección y Salud Pública FISABIO-Salud Pública/Universitat de València, Institute for Integrative Systems Biology (I2SysBio), CIBERESP, c/Catedratico Jose Beltran, 2, 46980 Paterna, Valencia, Spain
| |
Collapse
|
6
|
Sallam M, Şahin GÖ, Ingman M, Widell A, Esbjörnsson J, Medstrand P. Genetic characterization of human immunodeficiency virus type 1 transmission in the Middle East and North Africa. Heliyon 2017; 3:e00352. [PMID: 28725873 PMCID: PMC5506879 DOI: 10.1016/j.heliyon.2017.e00352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The HIV-1 spread in the Middle East and North Africa (MENA) has not been previously characterised using the phylogenetic approach. The aim of the current study was to investigate the genetic diversity and domestic transmission of HIV-1 in the MENA. METHODS A total of 2036 HIV-1 sequences available in Genbank and collected in the MENA during 1988-2016 were used together with 715 HIV-1 reference sequences that were retrieved from Genbank based on genetic similarity with the MENA sequences. The REGA and COMET tools were used to determine HIV-1 subtypes and circulating recombinant forms. Maximum Likelihood and Bayesian phylogenetic analyses were used to identify and date HIV-1 transmission clusters. RESULTS At least 21 HIV-1 subtypes and recombinant forms were prevalent in the MENA. Subtype B was the most common variant (39%), followed by CRF35_AD (19%) and CRF02_AG (14%). The most common genetic region was pol, and 675 partial pol sequences (average of 1005 bp) were eligible for detailed phylogenetic analysis. Fifty-four percent of the MENA sequences formed HIV-1 transmission clusters. Whereas numerous clusters were country-specific, some clusters indicated transmission links between countries for subtypes B, C and CRF02_AG. This was more common in North Africa compared with the Middle East (p < 0.001). Recombinant forms had a larger proportion of clustering compared to pure subtypes (p < 0.001). The largest MENA clusters dated back to 1991 (an Algerian CRF06_cpx cluster of 43 sequences) and 2002 (a Tunisian CRF02_AG cluster of 48 sequences). CONCLUSIONS We found an extensive HIV-1 diversity in the MENA and a high proportion of sequences in transmission clusters. This study highlights the need for preventive measures in the MENA to limit HIV-1 spread in this region.
Collapse
Affiliation(s)
- Malik Sallam
- Lund University, Faculty of Medicine, Department of Translational Medicine, Malmö, Sweden
| | - Gülşen Özkaya Şahin
- Lund University, Faculty of Medicine, Department of Translational Medicine, Malmö, Sweden
- Laboratory Medicine Skåne, Lund, Sweden
| | - Mikael Ingman
- Lund University, Faculty of Medicine, Department of Translational Medicine, Malmö, Sweden
| | - Anders Widell
- Lund University, Faculty of Medicine, Department of Translational Medicine, Malmö, Sweden
| | - Joakim Esbjörnsson
- Lund University, Faculty of Medicine, Department of Laboratory Medicine, Lund, Sweden
| | - Patrik Medstrand
- Lund University, Faculty of Medicine, Department of Translational Medicine, Malmö, Sweden
| |
Collapse
|
7
|
Chaillon A, Essat A, Frange P, Smith DM, Delaugerre C, Barin F, Ghosn J, Pialoux G, Robineau O, Rouzioux C, Goujard C, Meyer L, Chaix ML. Spatiotemporal dynamics of HIV-1 transmission in France (1999-2014) and impact of targeted prevention strategies. Retrovirology 2017; 14:15. [PMID: 28222757 PMCID: PMC5322782 DOI: 10.1186/s12977-017-0339-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background Characterizing HIV-1 transmission networks can be important in understanding the evolutionary patterns and geospatial spread of the epidemic. We reconstructed the broad molecular epidemiology of HIV from individuals with primary HIV-1 infection (PHI) enrolled in France in the ANRS PRIMO C06 cohort over 15 years. Results Sociodemographic, geographic, clinical, biological and pol sequence data from 1356 patients were collected between 1999 and 2014. Network analysis was performed to infer genetic relationships, i.e. clusters of transmission, between HIV-1 sequences. Bayesian coalescent-based methods were used to examine the temporal and spatial dynamics of identified clusters from different regions in France. We also evaluated the use of network information to target prevention efforts. Participants were mostly Caucasian (85.9%) and men (86.7%) who reported sex with men (MSM, 71.4%). Overall, 387 individuals (28.5%) were involved in clusters: 156 patients (11.5%) in 78 dyads and 231 participants (17%) in 42 larger clusters (median size: 4, range 3–41). Compared to individuals with single PHI (n = 969), those in clusters were more frequently men (95.9 vs 83%, p < 0.01), MSM (85.8 vs 65.6%, p < 0.01) and infected with CRF02_AG (20.4 vs 13.4%, p < 0.01). Reconstruction of viral migrations across time suggests that Paris area was the major hub of dissemination of both subtype B and CRF02_AG epidemics. By targeting clustering individuals belonging to the identified active transmission network before 2010, 60 of the 143 onward transmissions could have been prevented. Conclusion These analyses support the hypothesis of a recent and rapid rise of CRF02_AG within the French HIV-1 epidemic among MSM. Combined with a short turnaround time for sample processing, targeting prevention efforts based on phylogenetic monitoring may be an efficient way to deliver prevention interventions but would require near real time targeted interventions on the identified index cases and their partners. Electronic supplementary material The online version of this article (doi:10.1186/s12977-017-0339-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Antoine Chaillon
- University of California, San Diego, 9500 Gilman Drive, Stein Clinical Research Building #325, La Jolla, CA, 92093-0697, USA.
| | - Asma Essat
- INSERM CESP U1018, University Paris Sud, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, France
| | - Pierre Frange
- EA7327, Université Paris Descartes, Paris, France.,Laboratoire de Microbiologie Clinique, Hôpital Necker - Enfants Malades, APHP, Paris, France
| | - Davey M Smith
- University of California, San Diego, 9500 Gilman Drive, Stein Clinical Research Building #325, La Jolla, CA, 92093-0697, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Constance Delaugerre
- INSERM U941, Laboratoire de Virologie, Université Paris Diderot, Hôpital Saint-Louis, AP-HP, CNR VIH associé Primo infection, Paris, France
| | - Francis Barin
- INSERM U966 and National Reference Center for HIV, CHU Bretonneau and Université François Rabelais, Tours, France
| | - Jade Ghosn
- EA7327, Université Paris Descartes, Paris, France.,UF de Thérapeutique en Immuno-Infectiologie, Hôpital Hôtel Dieu, APHP, Paris, France
| | - Gilles Pialoux
- Service des Maladies Infectieuses et Tropicales, Hôpital Tenon, APHP, Paris, France
| | - Olivier Robineau
- Service Universitaire des Maladies infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Tourcoing, France
| | | | - Cécile Goujard
- INSERM CESP U1018, University Paris Sud, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, France.,Service de Médecine interne et Immunologie clinique, Hôpital Bicêtre, APHP, Le Kremlin-Bicêtre, France
| | - Laurence Meyer
- INSERM CESP U1018, University Paris Sud, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, France
| | - Marie-Laure Chaix
- INSERM U941, Laboratoire de Virologie, Université Paris Diderot, Hôpital Saint-Louis, AP-HP, CNR VIH associé Primo infection, Paris, France
| | | |
Collapse
|