Spatial epidemiology of recently acquired HIV infections across rural and urban areas of North Carolina

Margaret Carrel; Joseph J Eron Jr; Michael Emch; Christopher B Hurt

doi:10.1371/journal.pone.0088512

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Spatial epidemiology of recently acquired HIV infections across rural and urban areas of North Carolina

Journal article

Open access

Peer reviewed

Spatial epidemiology of recently acquired HIV infections across rural and urban areas of North Carolina

Margaret Carrel, Joseph J Eron Jr, Michael Emch and Christopher B Hurt

PloS one, Vol.9(2), pp.e88512-e88512

2014

DOI: 10.1371/journal.pone.0088512

PMCID: PMC3919766

PMID: 24520392

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Abstract

Transmission of HIV continues in the United States (US), despite prevention efforts aimed at education and treatment. Concurrently, drug resistance in HIV, particularly in patients being infected with HIV for the first time, poses a threat to the continued success of treatment for HIV positive individuals. In North Carolina, nearly one in five individuals with acute HIV infection (AHI) is infected with a drug-resistant strain, a phenomenon known as transmitted drug resistance (TDR). Few studies of AHI or TDR take into account both the spatial aspects of residence at time of infection and the genetic characteristics of the viruses, and questions remain about how viruses are transmitted across space and the rural-urban divide. Using AHI strains from North Carolina, we examined whether differences exist in the spatial patterns of AHI versus AHI with TDR, as well as whether the genetic characteristics of these HIV infections vary by rural-urban status and across Health Service Areas. The highest amounts of TDR were detected in persons under age 30, African Americans, and men who have sex with men (MSM)--similar to the populations where the highest numbers of AHI without TDR are observed. Nearly a quarter of patients reside in rural areas, and there are no significant differences between rural and urban residence among individuals infected with drug resistant or drug susceptible viruses. We observe similar levels of genetic distance between HIV found in rural and urban areas, indicating that viruses are shared across the rural-urban divide. Genetic differences are observed, however, across Health Service Areas, suggesting that local areas are sites of genetic differentiation in viruses being transmitted to newly infected individuals. These results indicate that future efforts to prevent HIV transmission need to be spatially targeted, focusing on local-level transmission in risky populations, in addition to statewide anti- HIV efforts.

Demography

Geography

Sexual Behavior

Adult

African Americans - genetics

Drug Resistance, Viral

Female

Genetic Variation

Health Services

Heterosexuality - statistics & numerical data

HIV Infections - epidemiology

HIV Infections - genetics

Humans

Male

North Carolina - epidemiology

Risk Factors

Rural Population - statistics & numerical data

Urban Population - statistics & numerical data

Young Adult

Details

Title: Subtitle: Spatial epidemiology of recently acquired HIV infections across rural and urban areas of North Carolina
Creators: Margaret Carrel - University of Iowa
Joseph J Eron Jr - University of North Carolina at Chapel Hill
Michael Emch - University of North Carolina at Chapel Hill
Christopher B Hurt - University of North Carolina at Chapel Hill
Resource Type: Journal article
Publication Details: PloS one, Vol.9(2), pp.e88512-e88512
DOI: 10.1371/journal.pone.0088512
PMID: 24520392
PMCID: PMC3919766
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Grant note: KL2 TR000084 / NCATS NIH HHS NIH NICHD R24HD050924 / PHS HHS 5P30AI50410 / NIAID NIH HHS P30 AI050410 / NIAID NIH HHS 8KL2TR000084 / NCATS NIH HHS R24 HD050924 / NICHD NIH HHS KL2 TR001109 / NCATS NIH HHS
Language: English
Date published: 2014
Academic Unit: Epidemiology; Interdisciplinary Programs; Geographical and Sustainability Sciences; Internal Medicine
Record Identifier: 9984259385502771

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