Newly Diagnosed Individuals in Molecular HIV-1 Clusters in Rhode Island Over 3 Decades

Characterizing clustering rates of people with HIV in high-risk populations can offer insights on the HIV epidemic, enhancing efforts to control its spread.

We investigated longitudinal dynamics of clustering rates among individuals newly diagnosed with HIV-1. Data were extracted from the medical records of all people with HIV in Rhode Island with available viral sequences. Partial pol sequences were grouped by HIV diagnosis year, and clusters were identified in annual phylogenies. Clustering trends were estimated within 11 sociodemographic variables with the Mann-Kendall statistic. Associations with clustering propensity and changes over time were tested via generalized linear mixed effects models.

HIV-1 sequences from 2630 individuals representing the statewide epidemic were analyzed across 33 annual datasets (1991-2023). Over this period, a continuous increase in clustering rates among newly diagnosed individuals was observed despite decreasing diagnoses over the last decade. Significant upward trends in clustering were seen among newly diagnosed men who have sex with men, males, the 21- to 40-year age group, non-Hispanic or Latino people, White persons, those with subtype B, and US-born individuals but not among people who inject drugs, females, and incarcerated individuals. Analyses of relative associations between groups within variables corroborated these results.

Analyses focusing on molecular HIV clusters among newly diagnosed people in a statewide epidemic over 3 decades revealed significant evolving trends among those at highest risk of HIV transmission, patterns not seen in the overall population. These findings inform the design and development of targeted public health interventions aimed at high-risk populations to curb HIV spread.