MOLECULAR EPIDEMIOLOGY OF HIV-1 SHOWS INTERMINGLING AMONG ARAB AND JEWISH MEN WHO HAVE SEX WITH MEN

Introduction

The increased incidence of HIV among men who have sex with men (MSM) is a major challenge in HIV prevention. MSM comprise ~30% of new HIV infections in Israel, a country with mixed and pluralistic Jewish and Arab populations. Here, we aimed to characterize the Israeli Arab and Jewish MSM (AMSM, JMSM) HIV-infected populations and identify possible inter-ethnical connections.

Methods

All Israeli-born, HIV-1-infected MSM reported between 2005 and 2016 were cross-matched with the National Civil Registry to identify religion (Jews/Muslim/Christian). Transmitted drug-resistance mutations (TDRM) and HIV subtypes were determined on partial protease (PR) and reverse transcriptase (RT) sequences obtained from treatment-naive patients. Phylogenetic trees were constructed and ancestral relationships between the HIV-1 sequences were assesed.

Results

Among the 1143 Israeli-born MSM identified, 6.4% (73/1143) were AMSM and 93.6% (1070/1143) were JMSM, with a median age of 33 years. Nighty-nine were diagnosed during seroconversion: 96 (96.9%) Jews and 3 (3.1%) Arabs (p=0.2). HIV-1 sequences from 84.9% (62/73) of AMSM and 41.1% (440/1070) of JMSM were available for further analysis. Subtype distribution was similar between both population groups: 80.6%, 8.1%, 4.8% and 6.5% of AMSM and 82.3%, 9.5%, 4.1% and 4.1% of JMSM carried subtypes B, A, C and non-A/B/C, respectively. Of all MSM, 13.1% (66/502) had TDRM, with RT-K103N/S, M184V, T215S and PR-L90M being the most common. TDRM prevalence was not affected by year of HIV diagnosis or by viral subtype and, although it was higher in JMSM than AMSM, the difference was statistically insignificant (p=0.1). Phylogenetic analysis demonstrated intermingling of HIV-1 sequences between AMSM and JMSM. Clusters of sequences with L90M, K103N/S or T215S TDRM included AMSM and JMSM.

Conclusions

Intermingling of HIV-1 sequences from AMSM and JMSM and common transmission clusters suggest inter-ethnical sexual contacts. Interventions aiming to prevent HIV-transmission in MSM should similarly address both populations groups.